Teen girls at infertility risk

August 8, 2013 at 12:39 pm


Reema Gehi, Mumbai Mirror Aug 8, 2013, 12.39PM IST
(Teen girls at infertility…)

Love for fast food and inability to handle stress is predisposing teenage girls to a hormonal disorder that raises risk of infertility and diabetes

Last year, a 17-year-old college student from Bandra visited gynaecologist Dr Rishma Dhillon-Pai, complaining of a delayed menstrual cycle. The teenager told Dr Dhillon-Pai that she would get her periods only on taking hormone medication. If she stopped the course, her cycles would stop too. At 5’2″, weighing 75 kilos, the teenager was overweight (her ideal weight should have been 52 kilos) and had excess facial hair. Dr Dhillon-Pai suggested that she undergo a battery of blood and hormone tests. These revealed that she had high insulin levels and an abnormally high LH/ FSH ratio (luteinising hormone and follicle-stimulating hormone — responsible for ovulation). She was found to be suffering from Polycystic Ovarian Syndrome (PCOS).

PCOS is a hormonal disorder among women which derives its names from the appearance of ovaries enlarged and containing numerous small cysts located along the outer edge of each ovary (polycystic appearance). PCOS interferes with the menstrual cycle causing either oligomenorrhea (few menstrual periods), hypermenorrhea (very frequent menstrual periods) or amenorrhea (no menstrual periods).

While doctors have reported a rise in the number of PCOS cases among adult women, it’s the high incidence among teenage girls that they find worrying. Dr Dhillon-Pai, a consultant with Lilavati and Jaslok Hospitals, says, “Of the total PCOS cases I see, 25 per cent are adolescents.”

While Dr Dhillon-Pai put her patient on a strict diet and exercise regime, the girl lost only a kilo over three months. When further tests showed that she was also insulin resistant, the teenager was put on a combination of insulin-sensitising drugs and low dose cyclical hormones (hormonal pills that help regularise periods). Six months later, she had lost eight kilos, her skin was free from acne and there was a dramatic reduction in facial hair.

Catch it early
With patients worrying most about skin problems such as, acne and excess facial hair, dermatologists are the first doctors the teens tend to consult. Irregular menstrual cycles are often ignored, attributing them to ‘hormones settling down’ during the teenage years. At his Bandra and Malad clinics, dermatologist Dr Sushil Tahiliani, sees nearly six to eight teenaged patients suffering from this condition every week. “With high levels of the male hormone testosterone in their body, they have unwanted hair in a pattern normally seen in men — hair on the face, chest and around the nipples. This also causes hair fall, thinning of hair, and darkening of complexion,” he adds.

These symptoms, says Dr Uddhavraj Dudhedia, an Andheribased consultant gynaecological endoscopic oncosurgeon, need to be caught early and shown to the doctor immediately. For correct diagnosis, it is best to consult a gynaecologist. PCOS is a complicated condition and your child may show one or a combination of all symptoms. The right specialist will be able to customise treatment according to the patient’s complaints.

Watch the insulin
However, the problem is not just cosmetic. Dr Dudhedia, who sees 15 cases a week, adds, “Such patients have high levels of serum insulin, insulin resistance and homocysteine (amino acids). Therefore, they have a tendency towards central obesity.”

PCOS is a condition which predisposes patients to other ailments. “Obese patients with PCOS are insensitive to insulin. This raises the risk of diabetes and metabolic problems. Over time, this could result in cardiovascular disorders and endometrial hyperplasia,” he points out. The condition can also affect reproductive capacity. Dr Dhillon-Pai says, “Most patients don’t ovulate (release an egg) every month and face issues when they want to conceive.”

How to correct it
While studies state that many patients are genetically predisposed to PCOS, eating excessive junk food, stress and a sedentary lifestyle increase the risk manyfold. Treatment, experts warn, will not cure the problem, but help manage it better. And it might mean being put on medication for a prolonged period.

Doctors suggest following a lowcarb diet with a low glycemic index (GI) where a significant part of total carbohydrates are obtained from fruits, vegetables and whole grain sources. “As the treatment is multidisciplinary (involving medical therapy, dietary alteration, exercise and sometimes a laparoscopic evaluation and procedure), it is important for the patient to stick to it,” says Dr Dudhedia.