My 17-year-old daughter has been diagnosed with polycystic ovary syndrome. She has been offered either the contraceptive pill, or injections of progesterone. We are concerned that this does not address the possible long-term effects, such as heart disease, hypertension and diabetes. We have read that new treatment options are available, including metformin, a drug that lowers insulin. Is this a feasible option, and is it available on the NHS?

Polycystic ovary syndrome is fairly common - up to five to 10 per cent of women may have it, depending upon exactly how the syndrome is defined. The usual symptoms are cysts on the ovaries, irregular periods that occur without ovulation, acne, obesity and excessive hairiness. In the past few years, researchers have discovered a link between polycystic ovary syndrome and diabetes and insulin. Many women with the syndrome seem to have high levels of insulin, and some go on to develop diabetes. It appears that these high insulin levels may actually cause the ovaries to grow cysts. Metformin is a drug that has been used for many years to treat diabetes. Women with polycystic ovaries who have cardiovascular risk factors, such as smoking, high blood pressure or obesity, should try to get these under control first. Many doctors will now treat these women with metformin, because this drug seems to make things somewhat better. If there is any sign that your daughter is developing diabetes or resistance to insulin, metformin is probably the best treatment for her. All this should be supervised by an endocrinologist. If she is not already seeing one, she should ask to be referred. Metformin is certainly available on the NHS.



I am pregnant and someone in my office has developed shingles. Is there any chance that I could catch it? How long will it take for the symptoms to develop? Will the infection do any harm to the baby?

Shingles is caused by exactly the same virus that causes chickenpox, which most people get during childhood. It is a relatively mild illness in children, and the rash usually disappears within a couple of weeks. The virus, however, remains in the body in a dormant state for many years. If it ever reawakens, it causes shingles to appear, so everyone who develops shingles really catches it from themselves. You can't catch shingles from another person who has it. The shingles rash does, however, contain live chickenpox virus. So if you are not immune to chickenpox because you have never had it yourself, and you come into contact with someone who has shingles, there is a chance of catching chickenpox from them. Chickenpox in pregnancy can cause problems for the baby, but only if you catch it in the very early or very late stages of pregnancy. So if you have never had chickenpox yourself and you are less than 20 weeks or more than 36 weeks pregnant, you should definitely seek urgent advice from your midwife or obstetrician.



Where can I get good objective advice about what immunisations I should have for travelling to South-East Asia, without going to an expensive private travel clinic?

Most commercial travel clinics will not charge you for advice, but they will charge you for immunisations. The UK Department of Health's website at www.doh.gov.uk/traveladvice gives simple, sensible advice on which immunisations are required and which are recommended for every country in the world. There is also advice about how to get medical treatment in various countries, and how to get an E111 form, which entitles you to treatment in European countries. Many GP practices run travel clinics, and you may find that you can get most immunisations for free from your practice nurse. If you have a complicated itinerary, or are going to countries where malaria is present, you will need specialist advice and probably a prescription for anti-malarial tablets. And don't forget that malaria is carried by mosquitoes. One good way to help prevent it is to use a strong insect repellent that contains DEET.


DN's story of dyslexia and a lazy eye:

More than 20 years ago, specialist eye tests found I had no binocular vision. I was 15. This explained why I am dyslexic - and hopeless at catching a ball. Visual input from my "lazy" left eye confused my visual memory so that I could not easily remember spellings. It was corrected with prisms and eye exercises, though I still have problems with spelling and read slowly.

I do get fed up with dyslexia "experts" who assume they have found the one cause and cure for the problem. All the dyslexics I know are affected quite differently by their problems, all of which require an individual approach. Ironically, my usual optician had not detected my "lazy" eye with the usual tests then in use.

I know of a lad who was almost put on Ritalin. Luckily, as an infant he had complex tests on his vision, which showed that his peripheral vision was poor, and he had not been paying attention in class unless his teacher was in his field of vision. Thankfully this subtle visual problem was spotted and treated in time.

Send questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions