Diagnosing Adolescent Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS), the most common female reproductive endocrine disorder, presents diagnostic challenges in adolescents, highlighting the need for adolescent-specific diagnostic guidelines for PCOS.

“We can’t use the adult criteria for diagnosing adolescent PCOS,” says Andrea Bonny, MD, section chief of Adolescent Medicine at Nationwide Children’s Hospital. The adult and adolescent diagnostic criteria for PCOS were outlined in a recent Clinical Obstetrics and Gynecology publication.

Pediatric endocrinology experts disagree on when PCOS should be diagnosed in adolescents and how much menstrual irregularity is normal during puberty.

“The PCOS phenotype begins during pubertal development. However, the phenotypic attributes in the adult diagnostic criteria can be normal phenomena in adolescents,” Dr. Bonny says. These attributes are hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology.

In recent years, the Endocrine Society, Pediatric Endocrine Society (PES), and the Amsterdam PCOS Consensus Workshop Group have developed adolescent PCOS diagnostic guidelines.

Each of these guidelines require the presence of clinical hyperandrogenism (e.g., acne) and ovulatory dysfunction, yet there are differences between the guidelines on these requirements. For example, the Amsterdam guidelines require that ovulatory dysfunction be present for at least two years. In the PES guidelines, though, ovulatory dysfunction is diagnostic for PCOS if menstruation has not started by 15 years of age or 2-3 years after thelarche.

Polycystic ovarian morphology is generally not included in the guidelines because this morphology is difficult to assess in adolescents.

“Treating adolescent PCOS can begin before a definitive diagnosis,” Dr. Bonny says, “especially if a patient’s symptoms are distressing. Treatment reduces these symptoms and the risk of comorbidities, such as obesity and psychiatric disorders.”

Obesity is a common comorbidity of PCOS. Weight loss has many benefits, including regulating menstruation, normalizing androgen levels and lessening insulin resistance. Unfortunately, insulin resistance can make weight loss difficult.

Medical therapies for adolescent PCOS are combined hormonal contraceptives (CHCs), spironolactone and metformin. These medications provide similar benefits as those associated with weight loss and also reduce acne. CHCs are often used as a first-line treatment.

“Clinicians should be mindful of treating the symptoms that could contribute to mental health comorbidities,” Dr. Bonny says. Untreated obesity and severe acne could contribute to anxiety, depression and eating disorders.

To date, adolescent patients with PCOS are not routinely screened for psychiatric disorders. Dr. Bonny recommends routine psychiatric screenings and subsequent treatment, if necessary, for these patients.

Reference:

Ebersole AM, Bonny AE. Diagnosis and treatment of polycystic ovary syndrome in adolescent females. Clinical Obstetrics and Gynecology. 2020 Sep;63(3):544-552. [Epub ahead of print]

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