Teenage Girls with Type-2 Diabetes predisposed to menstrual Irregularity

Teenage girls diagnosed with type 2 diabetes are predisposed to menstrual irregularity, a symptom of the polycystic ovarian syndrome (PCOS), according to a study published in the Journal of Clinical Endocrinology & Metabolism. The Multi-center study was conducted by Megan Kelsey, M.D., M.S., of University of Colorado School of Medicine in Aurora, Colorado, and colleagues, with an objective to determine the impact of youth-onset type 2 diabetes on reproductive function of girls.

PCOS is a hormonal disorder characterized by enlarged ovaries with small cysts on the outer edges — causes insulin resistance, the hallmark of Type-2 diabetes. Adult women with obesity are known to be at risk for menstrual disorders like polycystic ovary syndrome (PCOS), which can lead to the development of diabetes or other metabolic problems.

“It's important for girls with type 2 diabetes to be assessed for menstrual problems," said Dr. Kelsey. "Infrequent periods can be associated with heavy and painful periods, increased risk for fatty liver disease, fertility problems and long-term increased risk for endometrial cancer.”

The researchers performed a secondary analysis of the data from the Treatment Options for Type 2 Diabetes in Youth (TODAY) study, a nationwide research study to find the best way to treat young people with type 2 diabetes. The new analysis focused on evaluating the frequency of menstrual irregularity in girls with recently diagnosed diabetes and whether the addition of intensive lifestyle or rosiglitazone to previous treatment with metformin helped to improve symptoms. These treatments are often used to treat both diabetes and PCOS.

The researchers found that more than 20 percent of girls in the TODAY study had irregular periods. Many of those girls also had high testosterone levels, pointing to PCOS as an underlying cause. Not all the TODAY girls with irregular periods had elevated testosterone, suggesting other causes for menstrual dysfunction. Despite two years of intensive treatment with either metformin alone, metformin and lifestyle changes, or metformin and rosiglitazone, the participants still had significantly irregular periods.

"Our findings suggest that girls with youth-onset diabetes may need the additional intervention above and beyond their diabetes treatment to improve their menstrual health," Kelsey said.However the fact that 80% of the TODAY girls were on a maximum metformin dose at baseline means that the girls who also had PCOS would be considered treated at that time (metformin is also a treatment for PCOS) thereby masking some of the menstrual dysfunction that would have been present if the girls had been untreated.