Menstrual irregularity in the first postmenarchal years: an early clinical sign of polycystic ovary syndrome in adolescence

Abstract

We determined the hormonal, metabolic and ultrasonographic pattern of adolescents with menstrual irregularity since menarche but without clinical signs of hyperandrogenism with the aim of evaluating whether this condition represents an early stage of polycystic ovary syndrome (PCOS). These adolescents were divided in two groups: 13 adolescents with irregular cycles (IC) within the first 3 postmenarchal years (IC < or = 3) and 15 adolescents having persistent irregular cycles for more than three postmenarchal years (IC > 3). These adolescents were compared with 15 adolescents with PCOS and 18 normal adolescents. The values of free testosterone, free androgen index, luteinizing hormone (LH) and LH/follicle-stimulating hormone (FSH) ratio were similar in IC < or = 3, IC > 3 and PCOS, and higher than in the normal group (p < 0.005). The total testosterone and androstenedione levels were higher and sex hormone-binding globulin (SHBG) lower in PCOS only when compared with the normal group (p < 0.05). The ovarian volume was similar in IC < or = 3, IC > 3 and PCOS, and higher than in the normal group (p < 0.005). A higher incidence of polycystic structure was found in IC < or = 3, IC > 3 and PCOS, whereas normal structure was more common in normal adolescents (p < 0.0005). There were no significant differences in glucose and insulin parameters between groups. These results indicate that menstrual irregularity within the first postmenarchal years can be an early clinical sign of PCOS.

Polycystic Ovary Syndrome: Features, Diagnostic Criteria and Treatments

“…Menstrual irregularity is a common feature of PCOS, occurring in more than 75% of the adult PCOS population, and is often the earliest clinical manifestation in the adolescent [103,104]. van Hooff and colleagues observed polycystic ovaries in 9% of adolescent girls with regular menstrual cycles, in 28% with irregular cycles (average cycle length between 22 and 41 days), and in 45% with oligomenorrhea and found a similar association with higher androgen levels.…”

Evaluation of insulin resistance in adolescent girl with menstrual irregularities

“…7 Various literature shows that the levels of free testosterone, LH, and the LH/FSH ratio in adolescents with menstrual irregularity with no clinical signs of hyperandrogenism are similar to those of patients with PCOS and higher than those of adolescents with regular menstrual cycles. 3,7,18,28 In present study, we found significantly higher LH levels (p value<0.5), but not FSH levels (p value 0.4) in adolescent presenting with menstrual irregularities i.e.13 of 18 adolescents who met the Rotterdam criteria of PCOS had raised LH levels. The mean testosterone and DHEA-S levels in adolescents with menstrual irregularity were significantly higher than the control group.…”

“…7 In our study we calculated the fasting and postprandial glucose levels, none of the adolescents, either cases or controls, had abnormal values, probably because the elevation in the glucose levels begins only when (even with high serum insulin levels) the receptor resistance is such that the glucose levels cannot be controlled; in this stage the patient may present glucose intolerance, a step that leads to type II diabetes later on. This study confirms the previous findings that labetalol is an effective and safe drug for use in the control of blood pressure in pregnancy-induced hypertension.…”

“…The persistence of anovulatory cycles for more than 24 months after menarche, especially in association with other characteristics of hormonal disorders, suggest ovulatory dysfunction of pathologic origin. 7,8 The 2003 Rotterdam consensus workshop 9 concluded that PCOS is a syndrome of ovarian dysfunction, and that for its diagnosis two of three criteria must be present. The three criteria established at this consensus are: (1) chronic anovulation characterized by persistent menstrual irregularity for more than six months; (2) clinical and/or laboratory hyperandrogenism; and (3) ultrasonographic appearance of the polycystic ovary.…”

Difficulties in Diagnosis of Polycystic Ovarian Syndrome (PCOS) in Teens

“…We know that it is very common for girls to have irregular periods immediately after achieving menarche. Hypothalamic pituitary ovarian axis takes time to mature [1]. This endocrine function matures progressively over a period of many months and sometimes it may take one or two years to regularize after menarche.…”