Last week one young girl visited me with her mother at my clinic. The girl was quite upset with excessive acne (pimples) on her face and hair growth on her chin and upper lip. The mother narrated her menstrual history saying that her cycles are extremely irregular. She thought that as her menses has not been coming every month, she is putting on weight. I had an opportunity to talk to the girl and the mother in details so as to analyze her health issues.
She was suffering from a medical condition called Polycyctic Ovarian Syndrome (PCOS). The condition is very commonly seen in young girls amounting to 30 to 35 per cent of the population. Also, the incidence is increasing over a period of last five years due to the following reasons:
• The young girls after 10 years have a tendency to put an excessive weight – due to faulty diet, plenty of junk food (particularly refined products such as noodles, pasta, burgers and pizza)
• The physical activities like sports (outdoor), running, jogging, swimming are on decline
• Studies and attending different tuition classes make their schedules hectic and do not have enough time to look after their health
• The competition in every field either academics, sports, arts, music is very stressful for the young kids - sometimes difficult to cope up.
• Last, but not the least - there is lack of awareness among the young children and their parents about the healthy habits.
In this background, it would be worthwhile to know the scientific facts and solutions to different adolescent problems.
Physical health issues include:
• Irregularity of menstrual cycle
• Obesity
• Acne
• Excessive hair growth on face, chest and abdominal wall
• Excessive and prolonged bleeding during periods
• White discharge from the vagina
The menstrual cycle is considered normal, when the cycle starts without taking any medicine and the bleeding is over without any medication. The cycle is usually placed at an interval of 25 to 35 days and lasts from 3 to 5 days once it starts. The blood flow is average when 2-4 pads are required per day. Any deviation from the above parameters definitely needs to be addressed. The period pain is normal when it lasts for one to one and half day and ceases without any medication. However, if it is very severe associated with vomiting, loose motions and fainting episode and inability to carry normal routine activities, one should consult a doctor.
The regularity of menstrual cycle depends upon a healthy hormone levels. The endocrine glands like Hypothalamus, Pituitary (in the brain) and ovaries work in synchrony to get the ovulation (release of eggs from the ovary) regularly. This event of ovulation which occurs in mid-cycle (14th to 16th day) is the key factor for the regular menstrual cycle. In case of polycystic ovaries, the ovulation gets delayed by one to two weeks and sometimes months which upsets the complete hormone milieu.
Anovulation (absence of ovulation) increases the free testosterone levels which can cause acne either on face, back or chest. Also, some girls get excessive hair growth on their chin, lateral parts of their face and upper lip. They get dark pigmentation in their underarms, face, neck and tummy.
All these issues are usually associated with excessive weight gain, particularly around the waist and hips. Here, there is one important point to be noted – the obesity may be the cause of anovulation (absence of regular ovulation and menstrual cycle). Further, anovulation or polycystic ovaries can increase the risk of obesity in these girls. Hence, this sets up a vicious cycle. It is observed that these girls have a BMI (body mass index) always more than 25.
The girls having polycystic ovaries have one or all the features described so far. This reduces their self esteem and can cause mental problems like anxiety, irritability and depression.
Solution to this problem
It can be managed by three modalities.
1. Lifestyle modifications can be done along with counselling and de-stressing the individual with yoga and different pranayama and yoga sessions like yoganidra, positive affirmations and building self-belief. This takes time to understand and implement. However, this is the basis of long term cure for Polycyctic Ovarian Syndrome (PCOS).
2. The right combination of healthy diet and exercise. All the clinics that deal with adolescent problems have a team of consultant gynecologist along with nutritionists, yoga teachers and physiotherapists.
3. The medical treatment is with tailor - made medicines which ensures regular menstrual cycle, controls excessive hair growth and acne.
Sometimes in spite of taking medical treatment, the girls face a severe problem of acne and excessive facial hair growth. In these cases, several dermatological procedures like micro-peel therapy and laser treatment and others are useful. However, one must carry the treatment with an expert professional only, as it can hazardous for your healthy skin if done by wrong hands. The girl must take a proper medication and modify the lifestyle before jumping into any kind of skin treatment.
Some girls may face a problem of hair fall and troublesome vaginal discharge. For the hair fall, one must address the issues of faulty hair care. There are various reasons for hair fall like exposure to environmental pollution, lack of regular hair wash, use of strong chemicals in shampoos and conditioners. Also, deficiency Vitamins B12, Biotin, Anemia (low hemoglobin) and inadequate protein diet are the common causes of hair fall.
The vaginal discharge can be there in the girls who are not sexually active. The causes of this vaginal infection are dirty toilets and water as well as tissues papers in lavatories. If the discharge is offensive, itchy, curdy and yellow in color it definitely needs treatment. However, a watery, straw coloured discharge specially just before the menstrual bleeding is quite normal. One should always follow some hygiene rules to prevent occurrence of vaginal infections.
• Change of menstrual pads every eight hours whether soaked or not
• Clean the private parts with clean water or vaginal wash which contains lactobacilli. This vaginal wash rich in lactobacilli maintains the pH level of vagina on acidic side and prevents infection
• Always clean the vulva-vagina from urethra towards anus (up to down direction) and not the reverse way (from anus to urethra)
• One can use medicated wipes or own tissue papers while using public lavatories
• If the girls are sexually active insist the partners to use condoms
• If one is not sure about the male partner, she should get checked for STI (Sexually Transmitted Infection) before being sexually active.
One must remember your health is completely in your control. Though the conditions of Polycyctic Ovarian Syndrome (PCOS) and vaginal infections are extremely common, you can always get an expert advice which will help you to overcome these health issues.
(Author is a consultant gynaecologist &laparoscopic surgeon, Nanavati Super Speciality Hospital, Mumbai)