Adolescence Issue 7 by Sanjay Gole

Issue 07 | Pages 20

ADOLESCENCE

Adolescent Health Committee FOGSI

Address for correspondence : Olyai Hospital, Hospital Road, Gwalior- 474009 (MP) India. Phone : (91) -(751)- (2320616) http://www.youtube.com/watch?v=NsR0H0ril20

Adolescent Health Committee FOGSI

ADOLESCENCE Message from

Secretary General's Desk...

Dr. Nozer Sheriar Secretary General FOGSI 2012 Dear Colleagues and Friends, ‘Whether you think you can, or that you can't, you are usually right.’ - Henry Ford The adolescent health activities of FOGSI have of course been very effectively managed by the Adolescent Health Committee under the stewardship of a series of very dynamic chairpersons. The committee has striven for greater heights under Dr. Roza Olyai with regular publications, advocacy and national and international recognition. As the Website Coordinator, I have seen the great response of netizens to the six issues of the Adolescence Newsletter in our publications section. I wish Roza and the committee my very best and thank them on behalf of FOGSI for doing this very important work so sincerely. Keep up the good work!

Dr. Nozer Sheriar Secretary General FOGSI

Message from

From the

Message from

President FOGSI 2012

Dr. P. K. Shah Professor, Dept. of Obstetric & Gynecology Seth G.S.M.C. & K.E.M. Hospital Mumbai. It gives me immense pleasure to write a few words for the Magazine on “Adolescence”. Adolescence is a transitional stage of physical and mental human development generally occurring between puberty and legal adulthood (age of majority), but largely characterized as beginning and ending with the teenage stage. Adolescence is usually accompanied by an increased independence allowed by the parents or legal guardians and less supervision, contrary to the preadolescence stage. Adolescent Health Committee of FOGSI is playing vital role in imprinting knowledge to these Adolescent girls by organizing interactive workshops, seminars at the schools. It is our responsibility to share the feelings of these adolescents and their parents. In the concept of 'Maternal Health' the adolescent age is also included. I must congratulate to Dr. Roza Olyai, Chairperson – Adolescent Health Committee in bringing out the most useful informative and educative Magazine on adolescence. I am sure this Magazine will be a good, useful informative guide to adolescent girls, parents and doctors. I wish Dr. Roza and her team very successful & eventful tenure as Chairperson of the Committee.

World Health Organization

Gynaecologists and obstetricians could play two valuable roles in preventing early pregnancy and preventing poor reproductive outcomes in adolescents. Firstly, as specialist health service providers, you could provide adolescents with the information, advice, counselling and preventive and curative health services they need to stay well or to get back to good health, if they face health problems. Secondly - and just as importantly - you could play the role of change agents in your communities. You have credibility and influence and need to use this to help influential community members take adolescent pregnancy seriously. You could make an invaluable contribution in helping educators, religious leaders, political leaders, the media and others understand the needs of adolescents, and the importance of working together to respond to these needs. I am very pleased that the Adolescent Health Committee FOGSI has kindly agreed to feature the recently published WHO Guidelines in this newsletter. I hope FOGSI can work with WHO to disseminate these Guidelines widely and help ensure that their recommendations are acted upon and improve the lives of adolescents everywhere. Dr Elizabeth Mason Director, Department of Maternal Newborn Child and Adolescent Health World Health Organization

ICOG Secretary's Desk...

Yours sincerely,

From the

Vice President's Desk...

Dr. P. K. Shah President, FOGSI 2012

Dr. Jaideep Malhotra Secretary Indian College of Obstetric & Gynecology

Dr. Mandakini Megh Vice President FOGSI 2012 India's 22% of population are Adolescents with health challenges related to this group in particular to under - nutrition, anemia, increased maternal mortality largely owing to early pregnancy & sexually transmitted infections including HIV.

FOGSI Office Bearers 2012 Dr. P.K. Shah

President

Dr. Mandakini Parihar

Vice President No. 1

Dr. Laxmi Shrikhande

Vice President No. 2

Dr. Prashant Acharya

Vice President No. 3

Dr. Mandakini Megh

Vice President No. 4

Dr. P.C. Mahapatra

Immediate Past President

Dr. Nozer Sheriar

Secretary General

Dr. Hrishikesh D. Pai

Deputy Secretary General

Dr. Mandakini Megh

Dr. Jaideep Tank

Treasurer

Vice President FOGSI 2012

Dr. Parikshit D. Tank

Jt. Secretary

Providing healthy, safe and supportive environment to adolescents is imperative to enable this generation contribute significantly to societal growth. India's progress towards achieving the Millennium Development Goals – MDG 4 for reducing child mortality and MDG 5 for improving maternal health requires major efforts. I congratulate Dr. Roza Olyai Chairperson Adolescent Health Committee FOGSI for making significant efforts to enhance the accessibility of quality Adolescent friendly Health Services.

Dr. Roza Olyai M.S. MICOG, FICOG, FICMCH National Chairperson Adolescent Health Committee FOGSI (2009-12) Member Board of Governing Council Indian College of Obst. & Gyn.(ICOG 2012-15) Convener Adolescent Friendly Health Centers India Director Olyai Hospital,Gwalior-MP Email: rozaolyai@gmail.com http://www.youtube.com/watch?v=NsR0H0ril20

Dr Elizabeth Mason Director, Department of Maternal Newborn Child and Adolescent Health World Health Organization

From the

With regards

Chairperson's Desk...

Dear Fogsians and ICOGians, Greetings and best wishes from ICOG. At the outset let me thank you all for unanimously electing me to the post of ICOG secretary for the next three years. I also wish to congratulate Dr Roza Olyai for doing such a tremendous amount of work in the field of adolescents. Her efforts to reach out to the FOGSIANS and also to the adolescent girls all over India are really commendable. Efforts of starting adolescent clinics, help lines and websites and educational pamphlets by the adolescent committee and FOGSI are commendable. ICOG in the next three years has planned many academic activities for educating the service providers and making them aware of this special group “the adolescence”. ICOG will be organising CME's on PCOS and GDM apart from many other academic activities. We will be also having QUIZ and self evaluation tests and credit point programmes. I also take this opportunity to welcome all of you to the ICOG programmes and to join ICOG as members (MICOG). Efforts are on to get the MICOG/MRCOG exam conducted under the auspices of ROYAL COLLEGE OF OB GYN. Wishing you all the best of academics. Dr Jaideep Malhotra Secretary, ICOG

Dear Friends, It gives me great pleasure to share with you the seventh issue of the news magazine of the Adolescent Health Committee FOGSI. Am very happy that last year the committee has been awarded the prestigious Dr. Mehroo Dara Hansotia Prize –for the Committee chairperson's Best Activities for the year 2010-11. Our publication for the book title “Recent Advances in Adolescent Health” foreworded by Dr. Hamid Rushwan, Chief Executive FIGO, has been awarded the prestigious Dr. D.C. Dutta Prize for FOGSI Best Publication 2011. All this has been possible with your good wishes & support. Am thankful to Dr. Mason from WHO who has shared with us in this issue the WHO Guidelines which is being released globally & am very happy to have been part of the expert panel representing FIGO in this important session during the development of the guidelines. In this issue we have also covered important topics such as the new GDM initiative which Dr. Hema Divakar has under taken by involving our committee. We have also included PCOS,Contraception, Attention Deficit Disorder, Smart Diet for youth & Gynecological assesment of Adolescent girls. One of our major project this year is “Challenges for the youth today & tomorrow”. With encouragement & support from Dr.P.K Shah President FOGSI we will be covering more girls in the coming months through various school/ college health talks, sharing with them the informative booklets which our committee has prepared. This year we are having 24 Comprehensive Adolescent Health Care Workshops covering updated issues related to ARSH in various FOGSI societies. Young Women's club is a subsidiary club of the Adolescent Friendly Health Centers a National Project of the Adolescent Health Committee FOGSI. Am happy to note that Young Women’s club has been established in more FOGSI societies this year & is fast catching up in more FOGSI societies creating enthusiasm amongst the young girls who are interested to become members. Am very grateful to Emcure Pharma, specialy Mr. Arun Khanna, the COO of Emcure Pharma for his personal interest in supporting the activities of the Adolescent Health Committee FOGSI & helping to spread the message across the country through this magazine for the betterment of the youth. Your suggestions & feedback will be of great help, kindly share your articles & achievements with us. Do visit our website & share it with the adolescent girls. Wish you all a happy reading!

Dr. Roza Olyai National Chairperson Adolescent Health Committee FOGSI 2

Adolescent Health Committee FOGSI

ADOLESCENCE

The WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries

Dr. Elizabeth Mason Director Department of Maternal Newborn Child and Adolescent Health World Health Organization The WHO Guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries provides the evidence base to shape and reshape national policies and strategies. It contains recommendations on: •

•

preventing early pregnancy: by preventing marriage before 18 years; by increasing knowledge and understanding of the importance of pregnancy prevention; by increasing the use of contraception; and by preventing coerced sex preventing poor reproductive outcomes: by reducing unsafe abortions; and by increasing the use of skilled antenatal, childbirth and postnatal care.

Expand access to skilled antenatal, childbirth and postnatal care

Enable access to safe abortion and post-abortion services

Policy makers must intervene to expand the access to skilled antenatal care, childbirth care and postnatal care, especially for adolescents.

Policy makers must ensure that adolescents have access to safe, legal abortion services, and to appropriate post-abortion care, regardless of whether the abortion itself was legal. Adolescents who have had abortions must be offered post-abortion contraceptive information and services. What individuals, families and community leaders can do:

Increasing the use of contraception

Inform adolescents about the where they can obtain safe abortion services

What policy makers can do: Legislate access to contraceptive information and services Policy makers must intervene to reform policies to enable all adolescents to obtain contraception. Reduce the cost of contraceptives to adolescents

What policy makers can do:

Outcome 3 – Even in places where contraceptives are widely available, sexually active adolescents are less likely to obtain and use them than adults.

antenatal care and to get skilled care during delivery, and are likely to receive poorer quality of care.

All adolescents must be informed about the dangers of unsafe abortion, about safe abortion services that are legally available, and where and how they can obtain these services. Increase community awareness of the dangers of unsafe abortion Families and community leaders must be made aware of these consequences and build support for policies to enable adolescents to access abortion and post-abortion services.

Expand access to Emergency Obstetric Care Emergency obstetric care can be life-saving interventions. Policy makers must intervene to expand access to these emergency services, especially for pregnant adolescents. What individuals, families and community leaders can do: Inform adolescents and community members about the importance of skilled antenatal and childbirth care What health systems can do: Ensure that adolescents and their families and communities are well prepared for birth and birth-related emergencies Pregnant adolescents must get the support they need to be well prepared for birth and birth-related emergencies including creating a birthing plan. Birth and emergency preparedness must be an integral part of antenatal care for all pregnant adolescents.

Outcome 1 –

Policy makers should consider reducing the financial cost of contraceptives to adolescents, in order to increase their use by them.

What health systems can do:

Preventing early marriage

What individuals, families and and community leaders can do:

Identify and remove barriers to safe abortion services

Be sensitive and responsive to the needs of young mothers-to-be and mothers

Over 30% of girls in developing countries marry before the age of 18, and around 14% do so before the age of 15. Early marriage is a risk factor for early pregnancy and poor reproductive outcomes. Further, marriage at a young age perpetuates the cycle of under-education and poverty.

Educate adolescents about contraceptive use

Managers and health service providers must identify and overcome these barriers so that adolescents can obtain safe abortion services, post-abortion care, and post-abortion contraceptive information and services.

Adolescent girls must receive skilled - and sensitive - care antenatal and childbirth care, and if complications arise, they must receive emergency obstetric care.

What policy makers can do: Prohibit Early Marriage Policy makers must put in place laws to prohibit the marriage of girls before the age of 18 years and in countries where such laws are already in place, policy makers must ensure that they are enforced. What individuals, families and communities can do : Keep Girls in School Policy makers must increase formal and non-formal educational opportunities for girls at both primary and secondary levels.

Efforts to provide adolescents with accurate information about contraceptives must be carried out in combination with sexuality education. Build community support for contraceptive provision to adolescents Community members must be engaged, and their support obtained for the provision of contraceptives to all adolescents. Enable adolescents to obtain contraceptive services Health service delivery must be made more responsive and friendly to adolescents. Outcome 4 – Reducing coerced sex

Community leaders must work with all stakeholders to challenge and change norms around early marriage. Outcome 2 –

What policy makers can do:

Creating understanding and support for preventing early pregnancy

Prohibit coerced sex

Worldwide, one in five women have a child by the age of 18. In the poorest regions of the world, this rises to over one in three women. Adolescent pregnancies are more likely to occur among poor, less educated and rural adolescents.

Policy makers must formulate and enforce laws that prohibit coerced sex and punish perpetrators.

What policy makers can do: Support Pregnancy Prevention Programmes among Adolescents Policy makers must give strong and visible support for efforts to prevent early pregnancy. Specifically they must ensure that sexuality education programmes are in place. What individuals, families and community leaders can do: Educate all adolescents about Sexuality In order to prevent early pregnancy, curriculum-based sexuality education must be widely implemented. These programmes must develop life skills, support to deal with thoughts, feelings and experiences that accompany sexual maturity and be linked to contraceptive counselling and services. Build Community Support for Preventing Early Pregnancy Families and communities must be engaged and involved in efforts to prevent early pregnancies and sexually transmitted infections including HIV.

Outcome 6 – Increase use of skilled antenatal, childbirth and postpartum care

http://www.who.int/maternal_child_adolescent/documents/preventin g_early_pregnancy/en/index.html

In some countries, adolescents are less likely than adults to obtain

What health systems can do:

Girls in many countries are pressured into having sex, in many cases by people who are part of or close to their families-- in some countries over a third of girls report that that their first sexual encounter was coerced.

Influence Cultural Norms that Support Early Marriage

among 15-19 year olds per year. Unsafe abortions contribute substantially to maternal mortality deaths and to lasting health problems in many of those who survive them.

What individuals, families and community leaders can do: Empower girls to resist coerced sex Programmes that build self-esteem, develop life skills, and improve links to social networks and supports can help girls refuse unwanted sex.

Congratulations... Awards won at AICOG 2012 Mehroo Dara Hansotia Prize FOGSI Best Committee Activities Award for the Year 2010-11 Dr. D.C. Dutta Prize : FOGSI Best Publication 2011 Book title “Recent Advances in Adolescent Health” is Foreworded by Dr. Hamid Rushwan, Chief Executive FIGO was released during the AICOG 2011. The Editor of the book is Dr. Roza Olyai & the co-editor is Dr. D.K Dutta. The book is published by Jaypee publishers covers many aspects of ARSH.

Influence social norms that condone coerced sex Efforts to empower adolescents must be accompanied by efforts to challenge and change the community and gender norms that condone coerced sex. Engage men and boys to critically assess norms and practices Men and boys should be supported to critically look at the negative effects on girls, women, families and communities. This could persuade them to reject violent and coercive behaviours which they saw as normal. Outcome 5 – Reduce unsafe abortion An estimated 3 million unsafe abortions occur globally every year,

Our Heartfelt Thanks to all the Advisors, Committee members, City Coordinators & all those well wishers who were part of the various projects of the Adolescent Health Committee FOGSI. We would also like to thank the Companies for their support towards the various projects of the Committee.

Adolescent Health Committee FOGSI

ADOLESCENCE

Attention.... Adolescents !!

Dr. Krishna Kavita Ramavath MD, FICOG 2805, Veronia Dr, #103, PalmBeach Gardens Florida, USA 33410 Our attention is pure energy. With the power of concentration we can achieve our set goals and transform each moments in the same way alchemists tried to make gold. Arunhas been talking on the phone with his mom past 15 min. At the same time he is checking his Ipad for the latest videos, now and then checking his mail box to see his emails. Finally after he hangs up, he has a feeling of dissatisfaction. He feels that he has not really listened to her nor he has really checked his messages properly. This sort of behavior is so common these days with all the adolescents but more common with certain groups of them. Where in lies the problem? Research says that attention deficit is so common in the youngsters that many of them are not connected to what they think, do or feel at that precise moment. This could be another angle of attention deficit disorder of childhood. Attention Deficit Hyperactivity Disorder (ADHD) refers to a chronic biobehavioral disorder which initially manifests in childhood and is characterized by hyperactivity, impulsivity, and/or inattention. Not all of those affected by ADHD manifest all three behavioral categories. ADHD is, therefore, one of the most common disorders of childhood which progresses to adulthood. ADHD occurs two to four times more commonly in boys than girls (male to female ratio 4:1) While previously believed to be "outgrown" by adulthood, current opinion indicates that many children will continue throughout life with symptoms that may affect both occupational and social functioning. Some medical researchers note that approximately 40%-50% of ADHD-hyperactive children will have (typically non-hyperactive) symptoms persist into adulthood. These symptoms can lead to difficulty in academic, emotional, and social functioning. People with attention deficit disorder (ADHD) who aren't diagnosed in early childhood may begin to exhibit more obvious symptoms as they enter their teenage years. The increased demands of school, jobs, and new relationships may bring to the surface a teen's inability to stay focused, or impulsive or irrational behavior. Teens often have progression of the symptoms of ADHD that began in childhood, although they are expressed differently. They include: • Distractibility • Irritability • Poor concentration • Hyperactivity • Impulsivity • Insomnia During teen years, especially as the hormonal changes of adolescence are going on, symptoms of ADHD may intensify. Inattention and Distractibility This symptom is the most difficult to identify in childhood. The primarily inattentive ADHD subtype may not be recognized at all until a child grows into a teen. Although symptoms of inattentiveness begin during childhood, a child may be able to function fairly normally. Also, family members and other caregivers may be able to help the child to compensate, without realizing the problem might be ADHD. As adolescence approaches, inattentiveness may become pronounced along with distractibility, with the new demands from increasing academic workloads and other responsibilities. Problems usually develop that prompt an evaluation for ADHD during major transition points, such as when starting middle school, high school, or even college. Impulsivity and Poor concentration Because of their impulsivity, teens with ADHD are more likely to engage in risky behaviors, such as reckless driving, or using alcohol or drugs. Poor concentration leads to decreased performance. Often, 5

Single Step to Stop Diabetes teens with ADHD are so busy focusing on other things they forget about the task at hand. This can be seen especially with homework and athletic skills and in relationships with peers. Hyperactivity Obvious symptoms of hyperactivity may decrease during the teen years. But they may be replaced by fidgeting or feelings of restlessness. Other conditions Children with ADHD may have oppositional defiant disorder (ODD). If a child has ODD, it may lead to conduct disorder during the teen years, especially if left untreated. Learning disabilities, anxiety disorders, bipolar disorder, or depression may also coexist frequently and are under-recognized by many physicians. Diagnosis The diagnosis is established by satisfying specific criteria and may be associated with other neurological, significant behavioral, and/or developmental/learning disabilities. Treatment There are many opinions when it comes to treating ADHD in teens. Some experts believe that behavior therapy alone may work for teenagers. Yet, according to the National Institute of Mental Health, about 80% of those who needed medication for ADHD as children still need medication in their teen years. Typically, a combination of medication and behavior therapy is best in treating teens with ADHD. The American Academy of Pediatrics, American Medical Association, and the American Academy of Child and Adolescent Psychiatry all recommend behavioral intervention to improve behavioral problems that are a part of ADHD Most common therapy may consider the use of multi-modality approach, medication, behavioral therapy, and adjustments in day-today lifestyle activities. Role of Parents Parents can also help a teen with ADHD by making sure the teen gets plenty of sleep. Set firm rules for the TV, computers, cell phones, IPods, and video games. Make sure all of these are turned off well before bedtime. Also, parents should set firm limits and goals for the teen with ADHD. Reward positive behavior and seek help for a teen that exhibits frequent oppositional behavior. Well informed parents are sometimes greatest therapists to these youngsters as they have extraordinary capacity to focus on the child and are of invaluable help to the physician. In a Nut shell….. • The cause of ADHD has not been fully defined and may involve brain-chemical and genetic factors. • The diagnosis of ADHD involves many disciplines to include comprehensive medical, developmental, educational, and psychosocial evaluations. • ADHD can cluster in families. • Children with ADHD may require adjustments in the structure of their educational experience including tutorial assistance and parental guidance. • Medications are available to treat ADHD and can improve overall function. • Multimodality approach is best suited in long run. Article Sources: 1. CHADD: "Children and Adults with Attention Deficit Hyperactivity Disorder." 2. National Resource Center on ADHD: "Symptoms and Diagnostic Criteria." 3. CDC: "ADHD and Risk of Injury." 4. National Institutes of Health: "Severe Childhood ADHD May Predict Alcohol, Substance Use Problems in Teen Years."

Dr. Hema Divakar President Elect FOGSI 2013 Dear FOGSIANS,

•

ideal surveillence and management

A recap of what's been done and what's to be done ...

•

Postpartum and longterm care

It was Xmas time in December which marked the first meet of the core group and around the republic day in Jan. 2012 when the public forum on "wellness.com" happened @ Varanasi.

All of the controversies, literature reveiws , trail run of presentations, videobytes were furiously thrashed out and we agreed and disagreed and took back some homework.

The core group met again on 2nd March 2012 - to march ahead in their mission on SINGLE STEP TO STOP DIABETES and believe me their enthusiasm had not dampened one bit and their energy levels and commitment had doubled !!!

Universal screening with single step test Procedure is simple:

The group present to lead the discussions were Dr. Sanjay gupte, Dr. Hema Divakar, Dr. Suchitra Pandit, Dr. Roza Olyai, Dr. Atul Munshi, Dr. Sujata Misra, Dr. Parul Kotadwala, Dr. Susheela Rani, Dr. Ambarish, Dr. Parag, Dr. Girija Wagh, Dr. Hemant Deshpande, Dr. Himadri Bal Himadri, Dr. Uma Wankhede & Dr. Vaishali. The brainstorming sessions at this meet compelled every greycell in their brain to be at its best and the issues that were covered were ranging from: •

PCOS OBESITY and GDM link

•

Effective way of communicating for a life style change

•

Innovative ways for screening and diagnosis

75gm Glucose Challenge irrespective of timing of her meal and a single blood sample drawn at 2 hours excedes a value of 140 mg% to declare that she has GDM! And now G 75 is available but we have to come to terms with the ground reality that the implementation of the single step test is seriously off target and many GDMs are missed. "GOOD ENOUGH CAN BE GREAT" is the mantra! A number of CMEs to be organised by FOGSI ICOG with support from Uth Wellness Division of Emcure pharma will emphasise the need to perform a simple low cost feasible test and pay attention to every single pregnant women who has a potential to unfold into a GDM. Watch this space in the future issues of the "Adolescence Magazine" for more information from Research in India and Indian Guidelines for GDM from preconception to post partum.

Glimpses of the GDM Core Group Meet, Pune

Adolescent Health Committee FOGSI

Smart Diet for Youth Today

Mr. A.K. Khanna Chief Operating Officer and Executive Director - Member Board of Directors Emcure Pharmaceuticals Limited Adolescence, a period of transition between childhood and adult, is a golden period; period of dreams and a period to live out role models. A horde of physical and emotional changes characterize this particular age. Adolescents gain up to 50% of their adult weight, 20% of their adult height and 50% of their adult bone mass between 10-19 years of age. During this important time, there is a high incidence of nutritional deficiencies. High peer pressure and craze to match the latest trends leads to eating pizzas, burgers, aerated drinks, chocolates etc. Immediate and long-term complications include obesity, hyperlipidemia and sexual maturation delays. Eating fast food one or more times per week increases the risks for weight gain, overweight, and obesity. The prevalence of obesity or risk of future obesity is increasing. About 30% of children between ages 6-19 years are overweight or at risk of being overweight. Development of eating disorders is also prominent during this period. Nutritional Problems 1. Nutritional Anemia : Common deficiencies arise due to increased demand and inadequate intake of iron. Even deficiency of B group of vitamins may be common among vegetarians. Anemia can lead to reduced exercise stamina, stunted growth and lack of concentration amongst adolescents. 2. Obesity : Obesity in the childhood and adolescence heralds early onset of diabetes, hypertension and heart disease. Besides, it hinders in the development of the adolescent as he/she may face rejection by peers. 3. Eating disorders: There are certain kinds of eating disorders also specific to the youth of today: • Anorexia Nervosa : The adolescent is extremely thin but considers him / her as fat. They start skipping meals to lose weight. This disorder occurs more commonly in girls. Restriction of food intake causes metabolic and hormonal disorders such as irregular menses or complete lack of menstruation. • Bulimia nervosa: This is characterized by gorging on food followed by various behaviors (vomiting, use of laxatives, & extreme exercise in order to lose weight). A proper nutritional care, health education and psychotherapy can help to resolve these disorders and develop healthy eating habits. 4. Irregular meals and snacking : Some perceive themselves as too busy to worry about food, nutrition, meal planning or eating well. Those who skip meals and have more snacking events, have poorer glycemic control and less healthy dietary and leisure habits. When we miss a meal, our body thinks of conserving energy and slows down metabolism – when we eat next, our body tries to overcorrect the 'famine'-like situation it has experienced earlier. All these upset the sugar control. 5. Fast food and the media: Eating fast foods is popular with busy and media-influenced adolescents. Fast foods include foods from vending machines and self-service restaurants which mostly provide non-nutritious food. The term 'junk food' is usually used for food that is of little nutritional value and often high in fat, sugar, and/or calories. Junk foods typically contain high levels of calories from sugar or fat with little protein, vitamins or minerals. Common junk foods include salted snack foods, gum, candy, sweet desserts, fried fast food, and carbonated beverages. 7

ADOLESCENCE

Having realized the potential ill-effects of improper diet, it is imperative for us to design the diets of the young so that a balanced intake of nutrients is met which also meets their taste bud requirements. There are 3 basic principles to designing any smart diet: • Regularity: Short frequent meals are preferred than long bulky ones. • Quantity: food intake based on quality and nature of work. • Quality: All food groups to be included in order to make it nutritious. What is a balanced diet? A diet that strikes the right balance of carbohydrates, proteins, fats, vitamins, mineral and fibers to sustain a healthy body. Why is a balanced diet essential? • Good nutrition is required for proper growth. • To prevents deficiencies. • To ensure good health, glowing skin and hair. • To ensures high fitness level and improve physical endurance • To strengthen immune system • To improve concentration • To prevent long term complications of malnutrition or over nutrition Certain guidelines should be followed for smart diet for the youth today The basic building blocks of a balanced diet are carbohydrates, proteins, fats, vitamins and minerals. A balanced diet should provide around 60- 70% of calories from carbohydrates,10-15% from proteins and 20-25% from fat 3-5 servings of vegetable group and 2-3 servings of fruit group are essential to daily diet. • Adolescents need additional calories to provide energy for growth and activity. Boys aged 11 to 18 years need between 2,500 and 2,800 calories each day. Adolescent girls need approximately 2,200 calories each day. • Protein is important for growth and maintenance of muscle. Adolescents need between 45 and 60 grams of protein each day. • Adequate calcium intake is essential for development of strong and dense bones during the adolescent growth spurt. In order to get the required 1,200 milligrams of calcium, teens should be encouraged to consume three to four servings of calcium-rich foods each day. • As adolescents gain muscle mass, more iron is needed to help their new muscle cells obtain oxygen for energy. A deficiency of iron causes anemia , which leads to fatigue and weakness. Adolescent boys need 12 milligrams of iron each day, while girls need 15 milligrams Good eating practices also include: • Avoid overeating of junk foods like burgers, 'chips' and pastries. • Avoid aerated drinks; in fact, supplement the same with healthy drinks like coconut water, butter milk, fruit juice, milk shake etc. • Chew your food slowly as it takes some time for the brain to experience satiety. • Never skip any meal to lose weight. • Breakfast is an important meal as it prevents metabolic disturbances following an overnight fast. • A water intake of three to four liters per day helps to clean toxins away from the body • Exercising everyday has a big role to play in maintaining fitness levels. • Avoid canned or processed food as it contains preservatives that can be carcinogenic. • Dry fruits such as almonds, walnuts and raisins can be a healthy snack during studies instead of 'chips' or potato fries.

Role of supplements Having elucidated the basic concepts of a smart diet for the youth today, it is also important to stress on the fact that all the time it is not possible or feasible to have an exact diet pattern to meet the everyday requirements of all the essential nutrients. For all those special needs/growth spurts, it is wise to switch to an additional supplement, apart from diet. It may help to tide over, for example, that extra need of iron and calcium especially during menarche in girls. A supplement for proteins, which is definitely insufficient in Indian vegetarian diets, may actually help in building a muscle

mass body's architecture. Iron supplements during adolescence may counter the iron deficiency-induced fatigue and lack of concentration. Supplements may help to tide over the vitamin and mineral deficiencies of unbalanced diets. Hence, to say that a supplement actually adds up to completing the smart diet for young would be an appropriate remark. To conclude: good health and good nutrition go hand in hand & as today's youth is the future of the nation, we need to look after their diet & health in more special ways!

“Challenges for Youth Today & Tomorrow” Chennai, Tamil Nadu

Jamnagar, Gujarat

Report by Dr. S. Sampathkumari, City coordinator Adolescent Health Committee FOGSI

Report by Dr Kalpana Khandheria Executive Committee Member Adolescent Health Committee FOGSI Conducting regular Adolescent health awareness program in Jamnagar, recently took a session for 800 girls of M.D. Mehta School at Dhrol and 1300 girls of Hirpara Kanya Chhatralaya - Kalavad - Taluka Place.

Chennai society has been activity involved in the Adolescent Health activity programs in various colleges. Recently, Bharathi Womens College conducted its annual National Service Scheme Camp at a village called Erukkancheri near Chennai. About 170 students from all sections of the college participated in this camp. Dr. Mohanambal, Director I O G, Dr. Saraswathy, H O D, Balaji Medical College and Dr. S. Sampathkumari Hony. Secretary Chennai OBGY conducted the AHE workshop.

Navi Mumbai Report by Dr. Anu Vij, Executive Committee Member Adolescent Health Committee FOGSI

Congratulations...

Navi Mumbai has been an active society with regular programms organized towards Adolescent health issues. Dr. Anu Vij has recently conducted talk on Challenges faced by Today's Youth in JhunJhunwala College, Vashi. The talk was attended by 114 girls of 18+ age group and was followed by an interactive session.

Dr. Sanjeev Khurd from Pune For his new Research on “KHURD’S SPOTTED DEER SIGN - A New Sign for Diagnosis of PCOS” which received the Award for the Best Research in Infertility, during the recent 17th National Conference of Indian Society for Assisted Reproduction at Raipur. The paper will be presented at the ESHRE Conference in Istanbul. 8

Contraception in Adolescence

Dr.Fessy Louis .T Secretary KFOG ( Kerala Federation of O & G) Consultant Infertility Specialist and Laparoscopic surgeon CIMAR Cochin ,Kerala Use of contraception among adolescents, particularly those who are unmarried, is significantly different from that among older couples, and is influenced by educational, developmental, social, and psychological factors. The reproductive choices made by young women and men have an enormous impact on their health, schooling and employment prospects, as well as their overall transition to adulthood. Young women's reproductive choices are especially important, as early childbearing can impair their health and limit their prospects for productive participation in society. Adolescent Behavior and Sexual Activity : Reasons for becoming sexually active vary from individual to individual, and commonly evoked reasons include: getting closer to the other person, a way of communicating with the other person, pure pleasure, and expressing independence or adulthood. In the worst instance, this independence is pure rebelliousness, and has been labeled "sexual acting out". Adolescents rarely plan intercourse. In 70% of first intercourse, either there has been no attempt at contraception or the method used was relatively ineffective. The typical adolescent tendency to take risks and to believe that "it can't happen to me", along with the sporadic and unplanned nature of their sexual activity, places them at high risk for pregnancy. Risks of adolescent childbearing : Childbearing in the adolescent years imposes significantly greater health risks on both mother and infant. Pregnant teenagers continue to be particularly vulnerable to anemia, toxemia, prolonged labour, and delivery by Caesarean section in both developed and developing countries. Factors affecting contraceptive use : The first coital episode is usually a spontaneous event with both partners disavowing any conscious responsibility or advance intent. A minority of teenagers employ any method at their coital debut and subsequent use is unpredictable and erratic at best. The most notable feature of contraceptive behavior in adolescence is its inconsistency. Which Contraceptive Method ? The choice of contraceptive method remains, of course, a balance between the patient's wishes and medical considerations. The patient's intelligence, maturity, social situation, reliability, and medical status must all bear their weight in the physician's decision. Abstinence : Abstinence education generally focuses on delaying the initiation of adolescent sexual activity until marriage or adulthood. Many schools have adopted abstinence-dominant or abstinence-only education programs for school sexuality curricula. Research has shown that these programs do not hasten the onset or frequency of sexual intercourse and do not increase the number of partners that sexually active teens have Adolescents need to know about other contraceptive options before (or if) they decide to have intercourse. Male and Female Condoms : Latex condoms significantly reduce the transmission of some STIs and, therefore, should be used by all sexually active adolescents regardless of whether an additional method of contraception is used. Male condoms have several other advantages for adolescents, including involving males in the responsibility of contraception, easy accessibility and availability to minors, use without a prescription, and low cost. Polyurethane condoms can be used by adolescents with a documented latex allergy; however, latex condoms are preferred. Female condom could be useful if their male partners did not want to use a condom. The female condom also helps protect against STIs. Adolescents' concerns about using a female condom include difficulty of insertion, higher cost than male condoms, and appearance and noisiness of the device. Vaginal Spermicides : As with any barrier method, the effectiveness of spermicides depends on consistent and correct use. Spermicides 9

Adolescent Health Committee FOGSI

ADOLESCENCE consist of 2 components: a formulation (the gel, foam, suppository, or film) and the chemical ingredient that kills the sperm (eg, nonoxynol9). Use of spermicide alone in adolescents is not advocated as a contraceptive method; condoms must be used in conjunction with vaginal spermicides for protection against STIs

Adolescent Health Committee FOGSI Workshop The Adolescent Health Committee FOGSI Workshop was a great success at AICOG 2012 covering recent issues in sexual reproductive health. The workshop was well appreciated by FIGO & appeared in latest issue of FIGO news magazine.

Oral Contraceptives : Oral contraceptives remain the method of choice for most adolescent women. Three forms of OCPs are currently available: the fixed-dose, monophasic combination (each tablet contains the same dose of estrogen and progestin); the phasic dose (the triphasic and biphasic packs that contain varying doses of estrogen and progestin); and the minipill (which contains progestin only). The pill is also popular because it does not interfere with the spontaneity of sex and is the safest method of contraception available to the sexually active couple. Before selecting oral contraception for the adolescent patient, the physician should satisfy himself that the hypothalamic-pituitary-ovarian axis is mature. A low-dose pill is the best choice to begin with. OCPs have a failure rate of 0.1% when used perfectly.In adolescents may reach 15% to 26% because of noncompliance. US Food and Drug Administration (FDA) recently approved a monophasic 30g ethinyl estradiol/0.15-mg levonorgestrel pill for extended cycling called Seasonale, 84 days of continuous hormonally active pills followed by 7 days of placebo. Injectable Hormonal Contraception : Depot medroxyprogesterone acetate (DMPA) injection is a long-acting progestin that is given every 12 weeks (11–13 weeks) as a single 150-mg intramuscular dose. It has a very low failure rate of 0.3%. The main disadvantage of this contraceptive method for adolescents are menstrual cycle irregularities. A new formulation, which is administered subcutaneously, contains 104 mg of medroxyprogesterone acetate. Because DMPA suppresses circulating estradiol concentrations and it causes reductions in bone mineral density currently it is recommended to limit the use of DMPA to 2 years and using DMPA as long-term contraception only if other methods are inadequate. Progestin Implants : Levonorgestrel implants are ideal for adolescents who desire an extended length of protection. The major disadvantages for use in the adolescent population include high initial cost and potential adverse effects such as breakthrough bleeding and headaches. Intrauterine Devices : The intra-uterine device has been used successfully in the teenage population. When used appropriately, IUDs are generally safe, effective methods of contraception with a failure rate of less than 1%. Mirena, the IUD with progestin may be particularly useful for adolescents with severe menorrhagia and dysmenorrhea and is effective for 5 years Emergency Contraception : Emergency Hormonal contraception, previously known as the “morning after pill,” it is effective up to 72 hours after unprotected intercourse; it works by interfering with ovulation, fertilization, and implantation. The Yuzpe regimen is most commonly used and consists of two doses of 100 µg ethinyl estradiol and 0.5 mg levonorgestrel administered 12 hours apart. A regimen with similar efficacy is levonorgestrel alone administered in two doses of 0.75 mg each at 12-hour intervals. The insertion of an intrauterine device within 5 days after unprotected intercourse is another method. Mifepristone also is 100% effective as emergency contraception.

FIGO News Magazine appreciates

Adolescent Health Committee FOGSI Activities...

Newer Methods : New forms of contraception for males are also being studied, including an implantation system similar to Norplant, weekly and monthly hormone injections, and a contraceptive patch. Also vaccines like antiHcg, anti zona, antisperm are under study. Conclusion : In order to deliver that contraception to the adolescent, the physician must have an approach which takes into account the realities of the teenager's world. The use of media advertising to encourage adolescents to use contraception. Withdrawal continues to be a popular method of contraception among teenagers but it has a high failure rate (about 22.5% at 1 year). Frequent follow-up is important to maximize compliance for all methods of contraception, to promote and reinforce healthy decision-making, and to screen periodically for risk-taking behaviors and STIs. 10

Adolescent Health Committee FOGSI

ADOLESCENCE

PCOS in Adolescence A Challenge to Diagnose !

The Gynaecological Assessment of an Adolescent Girl

Dr Abha Singh Prof & Head Dept of OBGYN Pt JLN Medical College, Raipur

Dr. Narendra Malhotra MD, FICOG Past President FOGSI Introduction

PCOS is one of the most common endocrinal problems, affecting 1122% of adolescent girls. It is a condition which either remains asymptomatic or presentswith acne, hirsuitism, obesity, menstrual irregularities and infertility. DEFINITION : Though it has invited lot of debate but the international consensus agreed upon –

Adolescence is an important time for a girl, being the stage in her life when the child becomes a woman. Adolescent gynecology is not a new subject but it needs increasing awareness and further attention. Since the problems are specific to this group, setting up of separate adolescent clinics is desirable for efficient management.

Diet should comprise of:

A gynecological examination is an essential component of the health care of adolescent girls. Most adolescents are apprehensive about the examination of their genitalia, especially during a first examination. A sensitive approach to the adolescent's concerns and needs can aid in creating a positive and instructive experience.

“PCOS is present if two out of the following three criteria are met:

10% - Proteins

50% - Carbohydrates

Oligo & / anovulation

<30% - Fats

<10% - Saturated Fats

Hyperandrogenism (clinical or biochemical)

Polycystic ovaries on USG (12 or more follicles measuring 2-9 mm and increased ovarian volume more than 10 cm3) ”

Two fold increased glucose disposal rate is observed with 16% of weight reduction. Anti-obesity drugs:Orlistat is a pancreatic lipase inhibitor which prevents absorption of 30% dietary fat. Sibutramine is a centrally acting serotonin & noradrenaline reuptake inhibitor which enhances satiety. They improve Insulin Resistance, lipid profile & glycemic control. Both require monitoring for efficacy, and Sibutramine requires monitoring for BP. Bariatric surgery is indicated in morbidly obese girls in whom medical management is ineffective.

PCOS has its origin during adolescence and is associated with changes in lifestyle, overeating and under-exercising. It is difficult to diagnose in adolescents because the menstrual irregularity and anovulation is present even in normal adolescents. It is only over a period of 2 years that things become clear. Investigations: Hormonal profile

OGTT and fasting insulin

USG

• Thyroid function tests • Prolactin • FSH&LH • Free testosterone • DHEAS

• 17-OHP Long-term Sequelae: i)

ii)

iii)

iv)

Cardiovascular disease: Presence of obesity and metabolic disturbance in PCOS increases the cardiovascular risk in women with PCOS.

Dyslipidemia: Women with PCOS show presence of increased triglycerides and decreased HDL levels. It increases the cardiovascular risk in women. Endometrial cancer: the risk of developing endometrial cancer is increased in PCOS due to unopposed estrogens, infertility and obesity.

Breast cancer: Presence of obesity, hyperandrogenism as well as infertility in PCOS favors breast cancer.

vi)

Ovarian cancer: Few studies have suggested an association between PCOS and ovarian cancer due to use of associated multiple ovulations for assisted reproductive techniques.

Quality of life and psychological support: the girls often suffer from low self-esteem due to hirsutism and/or obesity. This leads to marked psychological stress. A psychological support by the clinician along with counseling for family support is extremely important for the mental, social and physical health.

Menstrual irregularity: COCP will result in artificial cycle & regular endometrial shedding. Suppression of ovarian function with oral contraceptives is usually the first line of therapy. It reduces circulating androgens by 50% & arrests progression of hirsutism. Other drugs commonly used are MPA and Dydrogesterone. Hirsutism: Cosmetic and medical strategies should be combined to target this. It may take 6-9 months before any improvement. Cosmetic measures like waxing, threading & shaving & chemical depilation are available. Besides cosmetic measures, combination of CyproteroneAcetate(2mg) which is anti gonadotrophic&antiandrogenicwith ethinyl estradiol(35mcg) must be prescribed to avoid irregular bleeding or amenorrhea due to endometrial atrophy. Spironolactone is another useful drug withweak diuretic and anti-androgenic properties. It is used in dose of 25-100 mg in women with hirsutism & acne in whom COCP are contraindicated.Drosperinone a derivative of Spironolactone is present in newer COCP.Other antiandrogens like ketoconazole, finasteride&flutamide not widely used due to side effects.

Diabetes mellitus type II : 20% of lean PCOS and 40% of obese PCOS show impaired glucose tolerance. This, combined with central obesity, accounts for higher incidence of DM type 2 in later life.

Management:

Obesity: Weight loss is recommended for anyone with BMI > 30kg/m2. It improves the hormonal milieu & the chances of ovulation. Aerobic exercise 3-4 times/week for 20-30 mint/session burns 100-200kcals/session. 40% improvement can be observed within 48 hrs.

Insulin-sensitizing agents: Metformin can reduce hirsutism, perhaps by reducing insulin resistance, and is administered to young girls to improve ovulation and hyperandrogenic symptoms such as hirsutism, acne & weight gain. Combination of (OCPs), antiandrogens, or metformin has been suggestedto be superior to monotherapy.

Conclusion:

Common Adolescent Problems •

Menstural Problems - Early or Late Menarche, Heavy Cycles, Dysmenorrhea, Irregular Cycles.

•

Mental Health - Depression, violent behavior, drug abuse

•

Nutritional Disorders

•

Sexually Transmitted Diseases

•

Pregnancy and Contraception

•

Attention Deficit, Conduct Problems

•

Disorders of Growth

•

Skin Disorders and Weight Management

Assessment of Adolescent Girl

Leave the room when the patient is changing, request removal of the minimum amount of clothing and provide a sheet or gown for the patient

Complete Tanner staging should be done.

Management •

Having taken a psychosocial history, consider adolescent health concerns in terms of risk and protective factors.

•

Give positive feedback for the things that are going well, as positive reinforcement goes a long way toward improving self esteem and cementing a positive, trusting relationship with the young person.

•

For young people who engage in significant health risk behaviors express concern and then ask them if they are willing to change their lives or are interested in learning more about ways to deal with their problems. This then leads to a discussion of potential follow up and therapeutic interventions. Where possible the main focus of management should be on short term goals.

•

Consider opportunistic vaccination including Hepatitis B & HPV.

•

Rest Give treatment after thorough investigations and manage accordingly.

Components of Adolescent Clinic These components include •

Confidentiality, Privacy

•

A welcoming,” teen-friendly" environment

•

An easy, uncomplicated appointments system

•

The reception and examination rooms should be arranged with furniture and instruments suitable for adolescent patients.

•

Availability of educational materials meeting the needs of adolescents.

•

Dedicated staff nurses to monitor patients, contact them for follow-up care, and manage appointment requests.

Background: •

•

Adolescent health care recognizes the young person's growing autonomy coupled with the diminishing role of the parent in promoting health and well being. Not all young people are at the same stage of development in the key areas of physical, cognitive and psychosocial development, despite being similarly aged. Whilst adolescents are generally healthy, psychosocial issues and risk-taking behavior figure prominently as causes of morbidity and mortality.

Communication style: •

A respectful and non judgmental approach should be used. Introduce yourself and explain your role.

•

Be Confidential.

•

Always try to gain trust of Adolescents.

Consent Requirements: •

It is generally accepted that most young people over 16 are capable of giving their own informed consent. Those younger may sometimes be considered mature minors.

Minors (< 18 years) may be able to give informed consent if they have sufficient understanding and intelligence to enable full understanding of what is proposed.

PCOS is often a misunderstood disease. PCOS is certainly not the end of their dreams for adolescents, but is a challenge to diagnose it correctly. Besides noting the presenting complaints & treating it, a thorough hormonal profile, OGTT, insulin levels & an ultrasound must be done for the correct diagnosis.

Female nurse or the Adolescent's mother to be present during examination, is recommended

With PCOS, life style modifications& loss of weight are of prime concern. Also, they should be made aware of the long term implications of the disease.

Consider privacy. Many young people are anxious about attending doctors for examination. The young person should be reassured that they have the final say about examination.

Explain the reason for the particular examination and give immediate feedback on findings.

Examination:

•

Pathology sample collection/Testing facilities

•

The close relationship between nurse, doctor, and patient

•

A teen-only phone line--greatly assists maintenance of confidentiality.

•

There should be a separate waiting and treatment area if it is located within the Gynec/ Paediatric department

•

The clinic should have its own health care practitioners and staff.

•

Clinicians should be trained in adolescent medicine.

•

The adolescent clinic should have a schedule dedicated routinely to teen patients.

For private practitioners adolescent clinics can be set up in their own consultation chamber with a walk in system or by having separate consultation hours for adolescents. Conclusion This adolescent period is hazardous for adolescent health due to absence of proper guidance and counseling. Family has a crucial role in shaping the adolescents behavior. They have to ensure a safe, secure, and supportive environment for the adolescents.Family members in the community to be informed and educated about adolescent problems. A positive and encouraging attitude has to be developed among the family members and parents. School teachers should be trained on adolescent health. Community leaders play a vital role on adolescent health care. The Adolescent Health Committee FOGSI has done tremendous amount of advocacy and awareness programmes in recent years.

Adolescent Health Committee FOGSI

ADOLESCENCE

Primary Ovarian Insufficiency in the Adolescent

"Challenges for Youth Today & Tomorrow" Project Events at AICOG 2012… Certificate of appreciation were given by FIGO representatives Dr. Hamid Rushwan & Dr. Arulkumaran to all the city coordinators who were part of the Challenges for youth project in 2011. Emcure Pharma was appreciated for their support of the activities of the Adolescent Health Committee FOGSI as part of their social corporate responsibility. Our heartfelt thanks to Emcure Pharma specially Mr. Arun Khanna COO Emcure Pharma for his constant encouragement & support, Mr. Atul Kichlu & Ms. Charu for their excellent coordination & Mr. Harshal with his team for their wonderful execution of this project since 2009 till date enabling both the doctors & the Adolescents to get maximum benefit from the various CME & health projects which were taken up under the “Challenges for youth today & tomorrow” project.

Dr. Manila Jain Kaushal MS, DNB, MRCOG (U.K.) MNAMS, FICOG Associate Professor, Department of Obstetrics & Gynecology, MGM Medical College, Indore (M.P.) Primary Ovarian Insufficiency in an adolescent population is poorly characterized and its incidence is unknown. It most commonly presents as primary amenorrhea, but may also present as a disturbance in a previously established menstrual cycle. It is an enigmatic and heterogeneous disorder characterized by amenorrhea, hypoestrogenism and hypergonadotropinism.

ultrasonography) are highly variable and are not predictive of future fertility or hormonal production in this population, but are currently undergoing investigation. Once primary ovarian insufficiency is diagnosed, karyotyping is indicated to determine if chromosomal abnormalities exist.

Etiology

Traditionally, the adolescent population with primary ovarian insufficiency has been treated in a manner similar to adult women with primary ovarian insufficiency. Although this may be appropriate on some level, the adolescent population is different from its adult counterpart. For adolescents with primary ovarian insufficiency, the objective of treatment is to replace the hormones that the ovary would be making before the age of menopause. Thus, this diagnosis is truly a chronic problem that emerges during a time of significant developmental changes, both physically and emotionally.

The predominant causes are different in the adolescent, and more of these causes are associated with permanent cessation of ovarian function. The more common causes of POF in adolescents include cytogenetic abnormalities involving the X chromosome, ovarian dysfunction occurring in association with other autoimmune endocrine disturbances. Adolescent follicle depletion or dysfunction is most often caused by chromosomal abnormalities i.e. gonadal dysgenesis with or without Turner syndrome. When adolescents present with primary amenorrhea and no associated comorbidities, 50% of these patients are found to have abnormal karyotypes. Thirteen percent of patients with secondary amenorrhea have also been noted to have an abnormal karyotype. Such affected females may have associated anomalies and failure to develop secondary sexual characteristics or may appear normal with some degree of puberty. Other causes involves damage from chemotherapy or radiation therapy, or is associated with syndromes like premutation for fragile X syndrome. Primary ovarian insufficiency may be a part of a multipleendocrinopathy, including hypoparathyroidism, hypoadrenalism, and mucocutaneous candidiasis or, less frequently, it is caused by viral infections or as a result of surgical extirpation. Diabetes mellitus, pernicious anemia, myasthenia gravis, rheumatoid arthritis, systemic lupus erythematosus, and dry eye syndrome have also been associated with primary ovarian insufficiency, and testing should be based on symptomatology. Diagnosis There is no consensus on criteria to identify primary ovarian insufficiency in adolescents, and delay in diagnosis is common. Although some girls will report hot flashes or vaginal symptoms like dryness or dyspareunia, the most common presenting symptom of primary ovarian insufficiency is primary or secondary amenorrhea. Because irregular menstrual cycles are common during early adolescence, and because this is also an initial symptom of early primary ovarian insufficiency, diagnosis can be difficult in this population. Although less than 10% of women who present with abnormal menses will ultimately have primary ovarian insufficiency, the diagnosis has such detrimental consequences on bone health that early diagnosis of this condition is important. Family history should be addressed because females with a family history of early menopause are at risk of primary ovarian insufficiency. Initial laboratory evaluation for suspected primary ovarian insufficiency includes measurements of FSH and estradiol levels, while also ruling out comorbidities. If FSH levels are greater than 30–40 mIU/mL, a repeat FSH measurement is indicated in 1 month. If the result indicates that FSH is elevated, a diagnosis of primary ovarian insufficiency can be established. Estradiol levels less than 50 pg/mL indicate hypoestrogenism. Antimüllerian hormone and inhibin B are being evaluated to determine their value in the diagnosis of primary ovarian insufficiency and currently are not required or needed for a diagnosis. Surrogate markers of ovarian reserve (presence of regular menses, serial serum estradiol levels, and antral follicle count by transvaginal 13

Treatment

Regardless of the etiology, patients with primary ovarian insufficiency are estrogen deficient. Thus, young women with primary ovarian insufficiency may need higher doses of estrogen than menopausal women to ensure adequate replacement and optimal bone health. There are currently no controlled studies addressing when secondary sexual characteristics should be induced or how to provide hormone therapy in this population. Practitioners must balance attainment of adult height with overall development of secondary sex characteristics when determining the timing and dose of hormone replacement. Combined hormonal contraception should not be used as first-line therapy in adolescents who have not completed puberty because they provide more hormones than physiologic replacement. For those who have not initiated or completed pubertal growth, consultation with a specialist in growth and development and hormonal therapy in children is desirable.

In 2012 we will be continuining with the Challenges for Youth Today & Tomorrow project with five Zonal TOTs inviting 20 society representatives as city coordinators from each zone. The Zonal TOTs will be coordinated by Dr. Anu Vij.

East Zone TOT 2012

Kolkata, W. Bengal Report by Dr. Jayita Chakravarty Coordinator East Zone Adolescent Health Committee FOGSI: East Zone TOT was held after the East Zone Yuva FOGSI at Kolkata on 6th May 2012 & was inaugurated by Dr. Roza Olyai, Dr. Basab Mukherji, Dr. Baskar Pal, Dr. Krishnendu Gupta, Dr. Mitra & Dr. Biswas President & Sec. Kolkata OBGY Society, with their team.

Fertility may persist even when few functional follicles are present. Because of occasional spontaneous resumption of ovarian function, there is a 5–10% chance of spontaneous pregnancy despite a diagnosis of primary ovarian insufficiency. Because exogenous estrogen is not completely effective in preventing osteoporosis in these women, calcium and vitamin D intake should be maximized and weight-bearing exercises encouraged as preventive measures. Monitoring bone mineral density annually in adolescents, and then every 2 years later is desired. Screening blood pressure at least annually and lipid levels every 5 years is recommended. When primary ovarian insufficiency is diagnosed in the adolescent female, the patient and her family are often unprepared for such news. They should be counseled on the effect of the patient's condition on future fertility. Referrals to a reproductive endocrinology and infertility specialist should be made when desired by the patient and family to further discussions on available reproductive treatments. Psychologic counseling should also be offered because an association between primary ovarian insufficiency, impaired self-esteem, and emotional distress has been reported after this diagnosis. Understanding the unique concerns and needs associated with the diagnosis and treatment of ovarian insufficiency in adolescents, provision of quality health care for this population is essential.

North Zone TOT 2012

Jalandhar, Punjab Report by Dr. Nidhi Garg North Zone Coordinator Adolescent Health Committee FOGSI North Zone TOT was held on 27th May 2012 at Jalandar & was inaugurated by Dr. Roza Olyai, Dr. Amita Sharma president Jalandar OBGY Society, with her team

Special challenges in the adolescent beyond establishing the diagnosis include counseling the young woman and her family and discussing the possibility of future pregnancy. Lifelong therapy must be addressed as well. Any discussion of POF raises numerous unanswered questions that should be the focus of future research.

Adolescent Health Committee FOGSI

ADOLESCENCE

Comprehensive Adolescent Health Care Workshop-2012

Establishing Adolescent Friendly Health Centers - FOGSI

This year under Dr. P.K .Shah President FOGSI’s theme “ Let the life of every mother & neonate count” the Adolescent Health Committee FOGS has been given 24 Workshops on Comprehensive Adolescent Health Care to cover up issues related to ARSH. A whole day workshop on topics related to ARSH (PCOS, Thyroid disorders, Unsafe Abortion, Teenage pregnancy, Puberty Menorrhagia, Sexually transmitted diseases, HIV-AIDS, Anaemia, Obesity & eating disorders in Adolescents, Contraception etc.) will be followed by a Public forum & inauguration of Young Women’s club which is a subsidiary club of the Adolescent friendly health centers in each society. A CD tool kit will be provided to the respective societies which contains ready made powerpoints on ARSH topics & details of the Young Women’s Club. For details of the same you may contact Dr. Roza Olyai Chairperson Adolescent Health committee FOGSI & Dr. Ajay Mane coordinator of the workshops. Special thanks to Dr. Anupama Dave & her team for helping in preparing the powerpoint material. We are thankful to Emcure Pharma for their support of this activity.

Raipur, Chhattisgarh

Amritsar, Punjab

Report by Dr. Abha Singh who coordinated the event : TOT was organized at Raipur inviting selective gynecologists. Chief guests were Mrs. Anju Gupta & Hon. Shri Rajeev Gupta, Chief Justice Chhattisgarh High Court who appreciated the committee activity. Dr. Roza Olyai shared details of the guidelines & the project. Young Women’s club was inaugurated at the end of the TOT.

Comprehensive Adolescent Health Care was a great success in Amritsar & was inaugurated by Dr. Roza Olyai, Dr. Madhu Nagpal, Dr Sujata Sharma, Dr. Amrit Dhillon president & Sec. Amritsar OBGY Society, with their team. The workshop was followed by inauguration of the young Women’s club & was well appreciated by the audience.

Trivandrum, Kerala Report by Dr. Nirmala, coordinator of the TOT: Dr. P. K. Shah President FOGSI, Dr. Mandakini Megh VP President FOGSI were the guests of Honor with Dr. Roza Olyai, Dr. Suchitra Pandit & Dr. Indirani Ganguli as special invitee.

Nagpur, Maharashtra A full day workshop on Comprehensive Adolescent Health Care was inaugurated in Nagpur by Chief Guest Mr. Nitin Gadhari (National President BJP). Other guests & faculty speakers present were Dr. Duru Shah, Dr. Laxmi Shrikande & Dr. Roza Olyai. The workshop was followed by the installation ceremony of the new team 2012 with Dr. Ankita Kote the dynamic president Nagpur society with her team 2012. Heartiest congratulations to team 2012 for a good start! Young Women’s club was inaugurated after the workshop, will have membership for girls ages 16-30 years. Local coordinator will be a gynecologists who will arrange for quarterly meetings for these girls. Each time a topic of social interest beside health issues will be discussed. The aim is to create awareness towards health issues & remove their doubts.

Congratulations... Dr. Neeta Yogendra Paharia, Senior National artist of India. On being awarded the letter of appreciation from the President of India, for her wonderful painting depicting breast feeding - "Amrit-Pan". Encouraging breast feeding among the women in India. Our best wishes for her upcoming solo painting show in Goa & Kolkata.

Adolescent Health Committee FOGSI

ADOLESCENCE

Establishing Adolescent Friendly Health Centers - FOGSI Gurgoan, Haryana Dr. Sabhyata Gupta coordinated the TOT for selective gynaecologists at Medanta Medicity - Gurgaon in the Department of OBGY. Dr. P.K. Shah President FOGSI was the chief guest during the event with Dr. Roza Olyai Chairperson Adolescent Health Committee FOGSI who shared details of the project. Young Women’s club was inaugurated after the TOT.

Young women's club has been inaugurated & established in more FOGSI societies this year & is spreading fast across India ! Bhopal, Madhya Pradesh Chief Guest Dr. Suchitra Pandit, Dr. Roza Olyai National Coordinator, Dr. Madhuri Chandra, Dr. Anjali Khanare, Dr. Archana Tripathi, Dr. Anita Shrivastava with their team of Bhopal Obstetric & Gyn. Society

Young women's club has been inaugurated & established in more FOGSI societies this year & is spreading fast across India !

Gwalior, Madhya Pradesh Chief Guest Mrs. Samiksha Gupta, Mayor Gwalior, Dr. Roza Olyai National Coordinator, Dr. Ratna Kaul, Dr. Jyoti Bindal, Dr. Veena Pradhan, Mrs. Mathur, Mrs. Daisy Bapuna & Mrs. Tina Olyai were present. During the same event book title “Smart Life@40 Plus” authored by Dr. Roza Olyai & Dr. Krishna Kavita Ramavath was released.

Pune, Maharashtra Chief Guest Dr. P.K. Shah president FOGSI with Dr. Sanjay Gupte, Dr. Duru Shah, Dr. Roza Olyai, Dr. Sunita Tandulwalkar, Dr. Girija Wagh, Dr. Kiran Kurtkoti, Dr. Dilip Walke, Dr. Mukta Umerji president Pune OBGY Society & Dr. Kishore Pandit Secretary Pune OBGY Society & their team 2012 during the installation ceremony & inauguration of young women’s club at Pune.

Upcoming Event :

Amrawati, Maharashtra Chief Guest Dr. Mandakini Megh Vice President FOGSI, Dr. Roza Olyai National Coordinator, Dr. Dr. Alka Kuthe, Dr. Asha Thakare, Dr. Manjusha Bokey, Dr. Babita Misar & their team of Amravati Obstetric & Gyn. Society

Dr. Roza Olyai Chairperson Adolescent Health Committee FOGSI has been nominated by FIGO to speak at the forthcoming XX FIGO World Congress at Rome during the WHO session on "Addressing adolescents in the context of preconception care".