Can we Prevent Anovulatory Androgen Excess (aka PCOS)?

Question

Hi there. I don't know if you can answer this or even if you will think it is a stupid question, but I am 41 and have a 12-year old daughter who got her period two years ago. I've struggled with PCOS since my teens and now I'm worried because I see my daughter following the same pattern. Her periods are every three or four months, she's gaining weight rapidly, has lots of pimples and is feeling very bad about herself.  So here's the question: Is there any way that we can stop her from getting PCOS? 

Answer

Thank you for your question. It is a very good one. You are a wise and perceptive mother to realize the similarity of your daughter's experiences and what you went through as a teen.
I'm so glad you asked because I believe that preventing full blown anovulatory androgen excess is something physicians and mothers should always try to do. With its far apart periods, acne and other evidences of too much male hormone and weight gain, it is very troublesome. By the way, the Centre for Menstrual Cycle and Ovulation Research [CeMCOR] and I call PCOS or Polycystic Ovary Syndrome, "Anovulatory Androgen Excess" (or AAE). AAE is more descriptive of the basic issues like not releasing an egg or making progesterone and on the higher than normal male hormone levels (androgen excess). PCOS usually gets treated like disease, but we consider AAE to be reversible, so that a woman with appropriate treatment can regain regular cycles, get rid of acne and unwanted hair and go on to have normal fertility and a healthy future.
You have likely talked with your daughter's family doctor about her periods and acne. The usual physician (or pharmacist's) recommendation is to go on the birth control pill as a treatment. However, all The Pill does is cover up the problem-it doesn't reverse it.
Here's what I suggest that you and your daughter do-first learn about what things are like right now so you and she can see changes as she improves. To do that, go to the CeMCOR website and download the Menstrual Cycle Diary that has two extra lines (http://www.cemcor.ca/files/uploads/Menstrual_Cycle_Diary_with_treatments.pdf).
Then go to the YouTube videos to watch so that she will know why and how to keep the Menstrual Cycle Diary. That may seem like a lot of work, but the more she learns to know her own body and cycles, the better she will recover. With the first cycle you record, make a fun game of each measuring each other's height (in a home doorway), weight and waist circumference (which indicates risk for diabetes if doubling it is greater than your height) and record hers in her Diary then and once a month. You'll have to decide where you want to record yours or if you, too, want to keep a Diary.
Because this AAE prevention requires the help of your family doctor, the next step is to engage that physician in this admittedly innovative process. Your doctor may protest, and you should reassure him/her that you are aware that there are no big studies showing that this will "work." I only know it to be a way to success because I have used it with many young women and they've markedly improved or totally recovered.
Briefly, the important idea is to ensure that your daughter knows that she won't end up struggling with funny periods, facial hair and infertility as she knows that you have. The success of the process I outline below is dependent on your daughter eating healthily (which needs to be her decision, but one that you can assist by having a variety of vegetables and fruits available and keeping junk foods out of the house). The other key foundation for preventing AAE is regular exercise. Please encourage her to walk for at least 30 minutes every day. The best way, if she is not in the "mom's-so-embarrassing phase" yet is to walk with her! If she is at all interested in sports, encourage her interests. If she is artistic, try to get her into local clubs or courses related to aesthetic activities such as rhythmic gymnastics or synchronized swimming or ballet.
I recommend starting by giving her back the natural hormone that she is missing which is cyclic progesterone. This will help to correct the hormonal imbalance in her brain. Most importantly, it will give her regular cycles, and help to decrease the acne. Surprisingly it will also help to prevent weight gain because taking it makes us burn about 300 extra calories a day! It is normal that the ovaries make progesterone for about 10-16 days toward the end of every monthly menstrual cycle. Take a look at the short article called "Cyclic Progesterone Therapy" (http://www.cemcor.ca/resources/cyclic-progesterone-therapy). She can start Prometrium (3 little white balls swallowed at bedtime) whenever she has been 14 or more days since the start of her last period. (She should take the round capsules and immediately go to bed and sleep-otherwise she may feel quite dizzy or "drunk.")
Next, she needs something to stop her ovaries from making too much male hormone called testosterone. To do this we need to block the testosterone receptors in her skin-a medicine that blocks testosterone receptors is called spironolactone. It is a medicine that we have had since the 1970s, it is quite safe, is not expensive since it is a generic drug and strangely enough it smells like peppermint! I suggest that she take one 100 mg tablet at bedtime every day. I expect that her acne will be gone in three months, especially if she washes her face with a mild soap and clear water twice a day.
I hope that this plan will allow her to gain no further weight until she has grown to her adult height so that she will have a late teenager-like body mass index (weight in kg divided by height in meters squared) of about 20. She should also know that, if changes in diet and exercise are not sufficient to prevent further weight gain or control an unreasonable hunger or sweet tooth, her physician can prescribe a safe and very effective medicine called Metformin. Most of all, this plan becomes something that can be your mother-daughter team effort.
Hope this is helpful for you.
I wish you and her all the best,
Jerilynn