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Polycystic ovary Syndrome in Adolescents: Pitfalls in Diagnosis and Management

  • Metabolism (M Dalamaga, Section Editor)
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Abstract

Purpose of Review

Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder during a woman’s reproductive lifespan, with well-documented diagnostic criteria and therapeutic strategies in adults; the same is not necessarily true for adolescents. The purpose of this review was to identify frequent pitfalls in PCOS diagnosis and management during adolescence.

Recent Findings

Although there is no global consensus on the definition, most experts converge to the presence of both oligo/amenorrhea and (clinical and/or biochemical) hyperandrogenism, as a prerequisite for diagnosis in adolescents. The former criterion includes: (a) consecutive menstrual intervals > 90 days even in the first year after menarche; (b) menstrual intervals persistently < 21 or > 45 days for ≥ 2 years after menarche; or (c) lack of menses by the age of 15 or 2–3 years after pubarche. However, these menstrual irregularity patterns may overlap with other common entities in adolescents, such as frequent or infrequent uterine bleeding or anovulation due to immaturity of the hypothalamic-pituitary-ovarian axis. Clinical signs of hyperandrogenism are obscure, without well-validated criteria. Finally, the criterion of polycystic morphology cannot be safely used in adolescents, mostly due to technical limitations of the transabdominal ultrasound. Except for the efficacy of lifestyle intervention in overweight and obese adolescents with PCOS, limited and low-quality data exist regarding the available medications, such as oral contraceptives, metformin, and anti-androgens.

Summary

Individualized management, guided by clinical experience and research data and close monitoring appear the most effective approach in this PCOS population for optimal control of its reproductive and metabolic outcomes. Research focusing on PCOS genetic and molecular mechanisms may elucidate what diagnostic and therapeutic strategies will be most appropriate in adolescents with PCOS in the future.

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Authors and Affiliations

  1. Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, 265 00, Patras, Greece

    Eirini Kostopoulou & Bessie E. Spiliotis

  2. Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Panagiotis Anagnostis & Dimitrios G. Goulis

  3. Unit for Human Reproduction, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Julia K. Bosdou

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  1. Eirini Kostopoulou
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Kostopoulou, E., Anagnostis, P., Bosdou, J.K. et al. Polycystic ovary Syndrome in Adolescents: Pitfalls in Diagnosis and Management. Curr Obes Rep 9, 193–203 (2020). https://doi.org/10.1007/s13679-020-00388-9

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