Young woman, 15 years of age, presented with class II obesity (BMI 37), irregular periods, hirsutism, and continuing to gain weight. Her first visit was with her mother.
We met and discussed the possibility of her having polycystic ovarian syndrome because of her symptoms. We confirmed with labs.
She and her parents were willing and open to try metformin and a lower carb meal plan. She tolerated the metformin and change in her meal plan. Lost weight and lost it slowly — very slowly. A pound per month if that. She tried to follow the meal plan as much as possible, but she was very active in sports and hung out a lot with her friends, and wasn’t really able to stick with things as she knew she should. Her periods didn’t really regulate.
She then went to summer camp for two months, and continued taking the metformin. While away she gained back the weight she lost plus another 10 pounds. She didn’t think she’d gain as she did because she was active, but aware that she wasn’t getting the right kind of foods for her.
She visited after camp, feeling demoralized and ashamed. We encouraged her that there was hope for her. We let her know it is not unusual for young ladies to go away to camp and find that they don’t have the healthiest food for the campers with not many choices. Along with her other symptoms, she now had acne.
We discussed behavior changes and let her know there is hope for her. We discussed her starting a low-dose oral contraceptive after I spoke with her parents. I informed them of the possibility of this increasing sexual activity knowing that she was protected from getting pregnant. The parents felt confident this would not be a problem, so they talked with her and told her it could help her acne. She was all for it. She was started on something after which her periods did regulate and her skin improved.
She started losing weight, but still very slowly and she was very discouraged. After much discussion, we started her on Adderral-10mg daily. Although not approved for obesity, she is an adolescent and there really aren’t many choices. She was so happy she felt a decrease in her appetite and she even improved in her studies. Her weight stabilized after 6 months. Although she was pleased with her progress, the plateau didn’t help. We then started topamax at 25mg/day for a month with the agreement that we would be in touch with her often and make sure she was tolerating the meds okay and losing weight. The 25 mg did not do much for her, but she was tolerating. We increased the dosage to 50 mg and she started losing weight again, as she is now. Still not as as fast as she would like but she’s not gaining and she’s not feeling discouraged. In fact, she is encouraged and communicates with me often about making lifestyle changes. She even wants to work on things she can do to not gain weight during this holiday season. We now have a “happy camper.” And, those of us who are older and understand the increased risks of PCOS, such as obesity, diabetes, endometrial cancer, infertility, heart disease, feel like we are averting some disasters with her — at least for now.
- PCOS is related to several complications. When patients are younger, decreasing health risks is usually not what motivates them to make behavior changes. Many times, for young women — while being careful to let them know you accept them as they are — outward changes are what they are more concerned about.
- Watch and listen to my interview with Dr. Andrea Dunaif and to my interview with Dr. Rhoda Cobin to learn more.
Joy Pape, FNP-C, CDE
Medical Editor, DiabetesInControl
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