Polycystic ovary syndrome (PCOS) is the most common cause of infertility in adult women, and often manifests in adolescence. The cardinal features of PCOS are hyperandrogenism, ovulatory dysfunction, polycystic ovaries, and insulin resistance, although not all will be present in an individual female. PCOS is associated with potential long term sequalae such metabolic syndrome, type 2 diabetes, poorer psychological health and possibly endometrial carcinoma and cardiovascular disease. The aetiology of PCOS remains poorly delineated.
Current guidelines caution against early diagnosis in adolescence, given that polycystic ovary morphology (PCOM) and ovulatory dysfunction are common in this age group and alternative diagnoses such as energy deficiency causing acquired hypogonadotropic hypogonadism may mimic PCOS. However, early recognition of PCOS potentially provides opportunities to encourage and embed lifestyle habits likely to minimise the sequalae of PCOS.
PCOS is diagnosed in adult women if at least two of the following criteria are met: ovulatory dysfunction, hyperandrogenism, and polycystic ovary morphology (PCOM) and assuming other endocrinopathies have been excluded. In contrast, in adolescent girls, PCOM is nonspecific and a diagnosis of PCOS or probable PCOS should be based on the presence of both ovulatory dysfunction and hyperandrogenism.
Lifestyle modification in all but lean PCOS underpins clinical management with potential gains in menstrual regularity, and reduction in metabolic risk. Pharmacological options to reduce the symptoms of androgen excess and ovulatory dysfunction vary between countries and there is sparse data with which to guide clinical management decisions in younger patients. Moreover, there is a lack of longitudinal data regarding the natural history of untreated PCOS and whether intervention has the potential to mitigate longer term sequalae and protect future fertility.
This brief presentation will focus on recognition and implications of a potential PCOS diagnosis in adolescence and suggest management strategies.