Phenotypic Characterization of Polycystic Ovary Syndrome in Adolescents Based on Menstrual Irregularity

Abstract

Objective: Polycystic ovary syndrome (PCOS) in adolescents is associated with adverse metabolic outcomes. The association of menstrual irregularity with metabolic risk among adolescents with PCOS was assessed. Method: A retrospective medical record review of 366 adolescents with PCOS aged 13-18 years was conducted, from which 265 girls newly diagnosed with PCOS were included and divided into those presenting with primary amenorrhea (PA), secondary amenorrhea (SA) and oligomenorrhea (OM). Androgen concentrations and markers of metabolic risk were compared among the groups. Results: Most subjects presented with OM (PA = 17, SA = 30 and OM = 218). Subjects with PA were younger than those with OM but not different from those with SA. Mean BMI was not different between groups. Total testosterone and insulin levels were higher in PA than SA and OM (p < 0.01 and 0.02, respectively). Fasting glucose was higher in PA than OM (p = 0.048) but not different from SA. Triglyceride levels were higher in PA than SA and OM (p < 0.001 each). More subjects with PA and SA had metabolic syndrome (52%) than those with OM (29.1%) (p = 0.027). The differences in triglycerides and glucose persisted despite BMI adjustment in multivariate regression models. Conclusion: Adolescents with PCOS presenting with PA are at risk of metabolic disease beyond expected based on BMI.

MANAGEMENT OF ENDOCRINE DISEASE: Diagnosis and management of primary amenorrhea and female delayed puberty

“…PCOS is the most common hyperandrogenic disorder in adolescent girls. PCOS may present as primary or more commonly secondary amenorrhea although oligomenorrhea is the most typical menstrual disturbance (78). The suggested diagnostic criteria for PCOS in adolescence are clinical or biochemical hyperandrogenism (calculated free testosterone, free androgen index or bioavailable testosterone using liquid chromatographymass spectrometry or extraction/chromatography immunoassays) with menstrual irregularity or primary amenorrhea and exclusion of other conditions that mimic PCOS (79,80).…”

“…Obesity or overweight is a common feature but not required for diagnosis. In PCOS adolescents, primary amenorrhea has been associated with more severe metabolic disturbances such as higher testosterone, insulin and triglyceride levels, and higher prevalence of acanthosis nigricans in comparison to PCOS with secondary amenorrhea or oligomenorrhea (78,81). Therefore, routine evaluation for type 2 diabetes, insulin resistance, dyslipidemia, and hypertension in PCOS patients with primary amenorrhea is justified.…”

Polycystic Ovary Syndrome in Adolescence: Challenges in Diagnosis and Management

“…After that, the following definitions of irregular menstrual cycles were reached by consensus, since there was insufficient data to formulate evidence-based ones: from 1 to 3 years postmenarche < 21 days or > 45 days; from 3 years postmenarche < 21 or > 35 days or < 8 cycles per year; and > 1 year postmenarche > 90 days for any cycle. 16 Primary amenorrhea is the absence of menstruation by the age of 15 years old or > 3 years post-thelarche 16 and, according to Javed et al, 25 it is associated with increased metabolic risk. Importantly, early menstrual patterns are predictive of the future ones and ovulation can occur even with irregular menstrual cycles.…”

Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies

“…Features of the syndrome classically emerge during puberty, but diagnosis can be difficult because irregular menstruation is common in normal development. 1 , 5 Excess body hair accumulates gradually, reflecting increasing duration of androgen exposure. Some girls (and women) with PCOS have severe acne vulgaris (predominantly on the lower face, neck, chest and upper back).…”