PCOS in Adolescents—Ongoing Riddles in Diagnosis and Treatment

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. A diagnosis of PCOS is established when a patient exhibits two of three Rotterdam criteria: oligoovulation or anovulation, excess androgen activity, and polycystic ovarian morphology. The pathogenesis of PCOS, as it affects adolescents, is often discussed in terms of a “two-hit” theory. This refers to a stepwise process in which the first “hit” is an inborn congenitally programmed predisposition, while the second “hit” arises from a provocative factor such as insulin resistance. The dynamic physiological and anatomical changes which occur in puberty make for a challenging diagnosis in this group of patients. It is important to be mindful of the physiological particularities in adolescence which often mimic the symptoms of PCOS. In their first-year post-menarche, approximately 75% of menstruating adolescents report their cycle to last between 21–45 days. Recent studies have shown that regular menstrual cyclicity is only achieved within 2–3 years post-menarche. Anovulation, as a crucial diagnostic element for PCOS, features in about half of early-post-menarchal adolescents. Hirsutism and acne are the most common clinical manifestations of hyperandrogenism, and mild features are developed by most adolescents as a result of elevated androgen levels. Distinguishing between a pathological sign and normal features of maturation is often difficult. A polycystic ovarian morphology (PCOM) through ultrasound has been found in up to 40%, 35%, and 33.3% of patients when assessed at 2, 3, and 4 years, respectively, after menarche. PCOM in adolescence is not associated with future abnormalities in ovulatory rate or menstrual cycle duration. For this reason, international guidelines recommend against the use of pelvic ultrasound until 8 years post-menarche. The primary aim of management is focused mainly on improving hormonal and metabolic status, the prevention of future comorbid complications, and generally improving the overall quality of life in young women with PCOS. Considerable controversy surrounds the choice of optimal pharmacological treatment to address PCOS in adolescents. Reliable studies, which include this sub-section of the population, are very limited. There is a lack of robust and reliable trials in the literature addressing the use of combined oral contraceptives. Further work needs to be undertaken in order to provide safe and effective care to the adolescent population in this regard.

Syndrome of hyperandrogenism in adolescent girls

“…• поликистоз яичников. Однако Роттердамские критерии не подходят для юных пациенток, поскольку многие здоровые подростки имеют поликистозную морфологию яичников в первые годы после менархе [17]. До недавнего времени применялись две группы критериев диагностики СПКЯ у девочек-подростков.…”

Probiotics and Polycystic Ovary Syndrome: A Perspective for Management in Adolescents with Obesity

“…Although the exact pathogenesis and etiology are still unclear, a complex interaction between environmental features, endocrine factors, and genetic predisposition is suspected to be the main etiopathogenetic factor [ 22 ].…”

“…Usually, metformin is used in adolescents with a BMI higher than 25 added to COCP. Metformin induces ovulation and reduces serum androgen levels and insulin resistance [ 22 , 40 ]. The association of metformin with insulin-sensitizing drugs, such as thiazolidinediones, has also been proposed, but its use in adolescents is controversial.…”

Pediatric Obesity: Complications and Current Day Management

“…Clinical features related to hyperandrogenism include acne, hirsutism, male-pattern alopecia, and reproductive dysfunction, including oligoamenorrhea and sub-fertility [67]. For adolescents, the most widely accepted diagnostic criteria are the National Institutes of Health (NIH) criteria: oligomenorrhea (≤8 menses a year) and clinical or biochemical evidence of hyperandrogenism [68]. PCOS should not be diagnosed in adolescents within 2 years post-menarche, as anovulatory cycles are common during this time unless there is a strong family history of PCOS.…”