Adolescent polycystic ovary syndrome according to the international evidence-based guideline

Abstract

Background: Diagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging because features of normal pubertal development overlap with adult diagnostic criteria. The international evidence-based PCOS Guideline aimed to promote accurate and timely diagnosis, to optimise consistent care, and to improve health outcomes for adolescents and women with PCOS. Methods: International healthcare professionals, evidence synthesis teams and consumers informed the priorities, reviewed published data and synthesised the recommendations for the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied to appraise the evidence quality and the feasibility, acceptability, cost, implementation and strength of the recommendations. Results: This paper focuses on the specific adolescent PCOS Guideline recommendations. Specific criteria to improve diagnostic accuracy and avoid over diagnosis include: (1) irregular menstrual cycles defined according to years postmenarche; > 90 days for any one cycle (> 1 year post-menarche), cycles< 21 or > 45 days (> 1 to < 3 years postmenarche); cycles < 21 or > 35 days (> 3 years post-menarche) and primary amenorrhea by age 15 or > 3 years post-thelarche. Irregular menstrual cycles (< 1 year post-menarche) represent normal pubertal transition. (2) Hyperandrogenism defined as hirsutism, severe acne and/or biochemical hyperandrogenaemia confirmed using validated high-quality assays. (3) Pelvic ultrasound not recommended for diagnosis of PCOS within 8 years post menarche. (4) Anti-Müllerian hormone levels not recommended for PCOS diagnosis; and (5) exclusion of other disorders that mimic PCOS. For adolescents who have features of PCOS but do not meet diagnostic criteria an 'at risk' label can be considered with appropriate symptomatic treatment and regular re-evaluations. Menstrual cycle re-evaluation can occur over 3 years post menarche and where only menstrual irregularity or hyperandrogenism are present initially, evaluation with ultrasound can occur after 8 years post menarche. Screening for anxiety and depression is required and assessment of eating disorders warrants consideration. Available data endorse the benefits of healthy lifestyle interventions to prevent excess weight gain and should be recommended. For symptom management, the combined oral contraceptive pill and/or metformin may be beneficial. Conclusions: Extensive international engagement accompanied by rigorous processes honed both diagnostic criteria and treatment recommendations for PCOS during adolescence.

Quality of life in adolescent girls with polycystic ovary syndrome

“…This limited our ability to systematically review the literature; however, this has been a common problem when evaluating any aspect of PCOS during adolescence, as highlighted by the recent international evidence-based guidelines. 12,13 An additional limitation of this review was the fact that the studies used multiple diagnostic criteria to diagnose the adolescent girls with PCOS, two studies did not specify diagnostic criteria and only one study reported on age of menarche, which is an important factor to determine menstrual irregularity (one of the diagnostic criteria for PCOS). Despite this, most of the studies (n = 6) used commonly accepted criteria, including menstrual irregularity and hyperandrogenism, 24,25,28,29,31,34 and only three studies 26,30,33 used Rotterdam criteria, 6 including pelvic ultrasound, which is no longer recommended for diagnosis of PCOS until 8 years post-menarche.…”

“…Research including larger sample sizes of better-defined populations, as recently described, is required in adolescent girls with PCOS, but further research in the area of emotional well-being is also required. 12 Additionally, research in QoL with a focus on normal BMI in adolescent girls with PCOS compared to healthy adolescent girls is necessary to draw clearer conclusions about the impact of the condition irrespective of the influences of an overweight or obese BMI.…”

“…[9][10][11] The diagnosis of PCOS during adolescence has been defined as irregular menstrual cycles according to time post-menarche and clinical signs of hyperandrogenism (hirsutism and/or moderate to severe acne) or hyperandrogenemia. 12,13 International evidence-based guidelines have been developed to better assess, diagnose and manage the condition, and these guidelines include a section on emotional well-being and QoL. 13 The adolescent recommendations of the guidelines have highlighted the limited data on adolescents and the importance of evaluating emotional well-being.…”

“…13 The adolescent recommendations of the guidelines have highlighted the limited data on adolescents and the importance of evaluating emotional well-being. 12 The evidence around QoL in women with PCOS was limited at the time in which the international evidence-based guidelines were developed and therefore clinical consensus recommendations were made by the guideline development group. 13 There were three recommendations in relation to QoL.…”

Fat Mass and Obesity Association gene Polymorphism in PCOS Iraqi Women

“…Stein and Leventhal who were firstly linked between PCOS and obesity in 1935 when 3/7 of first PCOS diagnosed patients were obese (3). The main features of this syndrome are oligo/anovulation, and disturbance in androgen hormones leading to different ranges of hirsutism, weight gain, acne, and amenorrhea according to Rotterdam criteria (4,5). Overweight or being obese with body mass index (BMI) greater than 30 kg/m 2 is a vigorous risk factor leading to PCOS women in around the age of 30 (5,6,7), in addition to represent a risk factor to cardiovascular disease, diabetes mellitus type 2, hypertension and several types of cancers (8).…”