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[quote=Anonymous]the most common reason for irregular periods is anovulation. anovulation can be caused by stress, being underweight or overweight, excessive exercise, inadequate caloric intake, thyroid dysfunction, pituitary dysfunction, and PCOS. PCOS is the most common cause. PCOS is a diagnosis of exclusion meaning that you need to rule out all of the above. If you can do so, PCOS is the likely diagnosis. Assuming that has been done, she would meet 2/3 Rotterdam criteria for a PCOS diagnosis (menstrual irregularities + symptoms of androgen excess [acne]). this is a chronic condition with no one size fits all treatment. treatment largely depends on if the person is or isn't trying to get pregnant. if not trying to get pregnant, treatment is focused on symptom control and health optimization (PCOS is associated with increased risk of metabolic dysfunction, heart disease, anxiety, depression etc). If primary concerns are irregular cycles and acne, a combined birth control pill is a good option as it will allow for more predictable bleeding pattern (no teen likes a surprise period!) as well as lower androgens to treat and prevent acne. Hormonal birth control gets a bad wrap these days but for those with hormonally driven issues (like PCOS), it can a real game changer. I typically prefer to use a pill that contains drosperinone. Assuming all other labs were fine and no concern for other possible etiology, endocrinology is unlikely to offer much more or different than gynecology. also assuming her estrogen levels were fine and she's not underweight, bone health (while important) wouldn't be my primary concern in someone with PCOS having infrequent periods. my concern would be that with chronic anovulation over many years, this can cause abnormal thickening of the uterine lining and increase the risk of precancerous and cancerous cell changes. a hormonal agent (like a pill) will help to keep the lining thin.[/quote]

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