Obesity, ovary disease link in teen girls
The Hartford Courant
Feb. 18, 2004 06:00 PM
A doctor in Hartford, Conn., thinks she has discovered another dangerous byproduct of America’s obesity epidemic: a sharp rise in a hormonal imbalance called polycystic ovary syndrome, which can lead to diabetes, heart disease and infertility.
Dr. Karen Rubin, a pediatric endocrinologist at Connecticut Children’s Medical Center, treated 200 teenagers with the syndrome last year — up from five in 1997.
Rubin, who is preparing to publish her findings, said she is convinced that the explosion in the syndrome among young women has a simple explanation: Teenagers, like the rest of the U.S. population, are too fat.
“It’s another epidemic on the coattails of the obesity epidemic,” Rubin said. Years ago, she said, “We would rarely see an adolescent with this hormonal/metabolic condition.”
Although the name implies that PCOS is a disorder of the reproductive system, researchers have discovered that ovarian cysts are only part of a constellation of symptoms that together can cause lifelong health problems.
One of the most dangerous hallmarks of PCOS is increased insulin production, which can lead to diabetes. Rubin thinks the increase in PCOS mirrors another national trend — a rise in the number of teenagers with Type 2 diabetes, a condition previously rare in children.
Doctors elsewhere in the country have reported some increase in the number of teenagers with PCOS, but none of those interviewed had seen anything approaching Rubin’s numbers.
“It’s possible that it’s manifesting earlier because girls are becoming obese earlier,” said Dr. Jean Emans, co-director of the Center for Young Women’s Health at Children’s Hospital in Boston. “But also, there’s much more awareness and early diagnosis.”
Girls with PCOS often arrive at a doctor’s office worried about irregular menstrual periods, acne or abnormal hair growth in locations such as the face, back or stomach. These symptoms are caused by higher-than-normal production of male hormones.
While the syndrome can be cosmetically embarrassing, its consequences are far more than skin deep.
Increased insulin production can signal the body to release extra male hormones, called androgens. The androgens interrupt normal ovulation and can cause male-pattern hair growth. But the real danger for girls with PCOS is the likelihood that they will develop Type 2 diabetes, and the serious health problems that can go with it.
With diabetes, the body is unable to efficiently process glucose, the blood sugar that is its main source of fuel. Insulin is the hormone needed for processing sugar. But in PCOS and diabetes, the body is unable to efficiently use insulin.
Like diabetes, obesity alone cannot cause a woman to develop PCOS. Both conditions have a genetic link. But Rubin is persuaded that girls who are genetically pre-programmed to develop PCOS could avoid it, or at least delay its onset, if they would lay off the soda, chips and other empty carbohydrates.
“If you knock off the obesity you’ll lessen all the features of the syndrome,” Rubin said.
Rubin and others said girls with PCOS who lose even 15 pounds frequently resume their monthly periods without the need for medication and see improvement in other symptoms. Those who are unable to lose enough weight can be treated with medications.
Moraith Bittel, a 17-year-old high school senior from West Hartford, Conn., was diagnosed with PCOS about a year ago after her mother noticed she was not having monthly periods.
While the active teenager acknowledges that she could stand to lose a few pounds, she has so far been unable to stick to the diet of fruits, vegetables, low-fat proteins and high-fiber grains that Rubin has prescribed.
Although Bittel knows that the condition could threaten her well-being in the future, worries about diabetes and heart disease have so far taken a backseat to filling out college applications.
Bittel recently started taking metformin, also known as glucophage, an insulin-lowering drug commonly prescribed for Type 2 diabetes.
“Losing weight is a problem; you constantly have to watch what you eat,” Bittel said. “I know I should, but I don’t.”
Rubin and her colleagues are preparing a report that she believes will document the direct link between obesity and adolescent onset of PCOS. Besides the staggering increase in the number of patients she’s seeing, Rubin said her teenage patients are overweight.
Only about half of adults who are diagnosed with PCOS are considered overweight, Rubin said. But almost 90 percent of the girls treated for PCOS at the CCMC clinic have a body mass index of more than 25, making them statistically overweight or obese.
Dr. Marilyn Richardson, a reproductive endocrinologist who sees a large number of girls with PCOS in her private practice outside Kansas City, said weight loss seems to improve PCOS symptoms, but many chicken-and-egg questions remain.
Girls with PCOS seem to accumulate fat around their middles, and not in their hips and thighs. Richardson said her patients are often physically active and do not eat more than their slimmer peers. She says the jury is still out on whether PCOS causes weight gain or weight gain triggers PCOS.
Richardson said factors other than obesity can predispose a young woman to PCOS. Girls whose birth weight was lower than normal, whose mothers had the syndrome or whose mothers had pregnancy-related diabetes seem to be more likely to develop PCOS.
Rubin said parents and pediatricians should be aware of the symptoms and possible familial factors that might make a young girl susceptible to PCOS.
“The hope is to increase the awareness, to get these kids diagnosed younger,” Rubin said. “That way, we can largely delay or prevent the adult morbidities.”
For more information on PCOS in teenagers, check the Boston Children’s Hospital Web site at www.youngwomenshealth.org.