18 year old DD and period/hormone issues

[Claudette7934]

Just after a bit of advice before insisting DD contacts her GP

She started her periods at 12, so she is definitely well over the whole puberty thing. She did suffer from quite bad PMT around the time of her GCSEs and she also looked really bloated just before her period and really struggled to perform well training for her sport in the week before her period.

Anyway, she went on the pill for a year (Yasmin) as she also had a boyfriend and was sexually active but came off it a few months ago when the relationship ended and she thought she had put on quite a bit of weight.

She has always been very slim/athletic. Size 6 and still does 2 sports to a high level and trains every day (sometimes twice a day). However, despite going on a sensible diet and still training a lot, she is not losing any weight. She still looks bloated. Periods are really erratic as well - 2 week gap and then 6.

I'm concerned that she doesn't seem to be eating that much (although I'm not concerned about eating disorders etc) and runs most days, goes to the gym, trains for a team sport that plays competitively several times a week - but she isn't losing any weight. Even 50 year old menopausal me would see the weight drop off with that lifestyle.

I do think there is something hormornal going on but I'm a bit baffled by it all. She is reluctant to talk to the GP, so I just want to nudge her along a bit.

PCOS would cause irregular periods and hard to shift weight, especially around the belly.

I would suggest a blood test to check hormone levels as a potential starting point.

Need to go to the GP. Bloating and unexpected weight gain are red flags.

But on balance it is likely just the be the end of puberty as lots of girls fill out in their late teens and plateaus at 18-20. Google “weight gain late teen girls”.

intense training can affect periods too. I took Yasmin and it is classed as one of the better pills

I would advise her to see a GP and have blood tests done to check her hormone levels particularly luteinising hormone and follicle stimulation hormone. With PCOS there is often an excess of LH compared to FSH.

PCOS can also cause bloating and her periods should be more regular. Such gaps can also be caused by PCOS.

Yasmin is often prescribed because of its anti androgenic qualities associated with PCOS.

Get her to go to the GP defintely, she very likely has PCOS.
PCOS diagnostic criteria is three things - you need to have 2 out of 3 for a diagnosis. Which are 1. persistent irregular, short, and missed periods. Then for PCOS you also need 2. on a transvaginal ultrasound to see lots of small follicles near the ovaries and/or 3. certain hormones at a higher level than normal.

Also get them to do a whole set of bloods, and also some other hormones, to see whether she qualifies for that part of the criteria.
Blood test wise I'd probably ask for:
• Total testosterone
• Sex Hormone Binding Globulin
• Free Androgen index
• Fasting glucose + insulin
• Lipid panel (cholesterol, triglycerides)
• Vitamin D
• Thyroid panel (TSH, free T4)
• Hirtuism blood panel as well. I'd also use vitamin B6 and D supplements as they can be helpful with energy, also for periods.

Then you do need to start some form of contraception because you need uterine protections especially as with PCOS it can be a 2-5 x higher risk of uterine cancer, so it is so important to protect from that.
This video explains it in quite a lot of detail but very understandable as well, definitely have a watch https://www.instagram.com/reel/DPRWvOkEeGJ/?igsh=dDJlMjc4dGxmbHh5

The pill/mirena coil is there to treat the symptoms,* it treats PCOS, if anything it is the best for the PCOS. It is a treatment for acne, it treates heavy periods, missed periods, irregular periods, it treats hirsutism, it treats the risk of uterine cancer. Saying that it 'masks' PCOS is like saying 1. PCOS symptoms are normal, which they are not, and like insulin masks diabetes. I would recommend either Yasmin or the mirena coil, it will also thin her uteurs lining with progesterone, so then there's not a lot to bleed so she'll have lighter periods and some people's periods stop all together. *This is okay, as it is due to the progesterone working, the lining is thin and so the risk of hyperplasia is not the same as missing or not having a period naturally.

Other meds are things like metaformin or orlistat for insulin resistance, managing risks of potential high BP, etc. Also meds for excessive hair growth or hair thinning.

PCOS is not simply 'hormonal imbalance' - that is not a medical term, your hormones in non-PCOS patients and PCOS patients are meant to be imbalanced. They fall and rise in response to changes in the body e.g insulin being released when you eat or FSH being released when you have your period to stimulate a follicile to grow, or T3+T4 being released when your body temp drops to increase heat production and metabolism.

PCOS is medically defined as hormonal deregulation - a different thing, so it is not using the hormones it has (which are in the right amounts) properly. So insulin resistance is common in PCOS because your body procedures insulin but doesn't respond to it correctly, the same for androgens etc. PCOS is more about bio-chemistry and genetics which you cannot fix, lifestyle changes, hormonal meds etc can help to managae it and get your body to regulate and respond and flucatate hormones properly. You need to fight bio-chemistry with bio-chemistry; meds.

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Depending on your issues, you could ask your GP to refer her to see an an endocrinologist, gynecology and a dietitian as well. But you should also ask for the bloods I mentioned earlier because then they can whether she has PCOS, whether her risk of diabetes is increasing, if she has worsened insulin resistance (which she likely does as you can have that whilst being slim, and explains her struggle to lose weight), how her androgens are being managed etc - from there she can get referrals for secondary care to endocrinology.