Polycystic ovary syndrome in adolescence: diagnostic and therapeutic strategies

Abstract

Controversy continues about the underlying etiopathogenesis, diagnostic criteria, and recommendations for polycystic ovary syndrome (PCOS) in adolescents. Recent literature has recognized these deficiencies and evidence based expert recommendations have become more available. The purpose of this chapter is to offer primary care providers a practical understanding and approach to the diagnosis and treatment of PCOS in adolescents. Although the presence of polycystic ovary morphology (PCOM) is included as a key diagnostic criterion of PCOS in adults, it is currently not recommended for the diagnosis in adolescents. As such, the diagnosis of PCOS in adolescents currently hinges on evidence of ovulatory dysfunction and androgen excess. Recommended evidence of ovulatory dysfunction includes: consecutive menstrual intervals >90 days even in the first year after menstrual onset; menstrual intervals persistently <21 or >45 days 2 or more years after menarche; and lack of menses by 15 years or 2-3 years after breast budding. Recommended evidence of androgen excess include: moderate to severe hirsutism; persistent acne unresponsive to topical therapy; and persistent elevation of serum total and/or free testosterone level. Importantly, a definitive diagnosis of PCOS is not needed to initiate treatment. Treatment may decrease risk of future comorbidity even in the absence of a definitive diagnosis. Deferring diagnosis, while providing symptom treatment and regular/ frequent follow-up of symptomology, is a recommended option.The treatment options for PCOS should be individualized to the presentation, needs, and preferences of each patient. Goals of treatment are to improve quality of life and long-term health outcomes. Lifestyle modifications remain first-line management of overweight and obese adolescents with PCOS. Combined oral contraceptives (COC) are first line pharmacotherapy for management of menstrual irregularity and acne, and metformin is superior to COCs for weight reduction and improved dysglycemia. COCs and metformin have similar effects on hirsutism, but often need to be paired with other treatment modalities to achieve further improvement of cutaneous symptoms. Clinicians should be cognizant that PCOS is associated with significant metabolic and psychological comorbidity and screen for these issues appropriately.

What does acne genetics teach us about disease pathogenesis?

“…A number of GWASs have been performed for PCOS . Hormonal therapies are a well‐tolerated and effective way to control acne with and without endocrine disorders . CAH is linked to endocrine abnormalities with deficiency in the synthesis of cortisol from the adrenal cortex .…”

“…[134][135][136][137][138] Hormonal therapies are a well-tolerated and effective way to control acne with and without endocrine disorders. 139,140 CAH is linked to endocrine abnormalities with deficiency in the synthesis of cortisol from the adrenal cortex. 92,141 The majority of patients with classical or nonclassical CAH presentation have mutations in CYP21A2 (Table 1).…”

The effect of progressive muscle relaxation on depression in polycystic ovarian syndrome

“…1 It is associated with significant morbidity including impaired reproductive health, psychosocial dysfunction, metabolic syndrome, cardiovascular disease, and increased cancer risk. 2 PCOS is accompanied by an array of symptoms such as obesity, acne, scalp hair thinning, menstrual irregularity, and sub fertility. These symptoms can also contribute to psychological impairment.…”

“…4 Clinicians should be cognizant that since PCOS is associated with significant metabolic and psychological co morbidity and screening should be executed properly. 2 Polycystic ovary syndrome (PCOS) manifests itself with various symptoms; therefore, it interests representatives of many medical specializations. 5 Women with PCOS on average tend to experience mildly elevated anxiety and depression, significantly more than women without PCOS.…”

Study of prevalence and determinants of polycystic ovarian syndrome among adolescent girls in rural area: a prospective study

“…3 Due to theses variations, the practice of using adult diagnostic criteria raises the concern for misdiagnosis in adolescent age group. 4 At the same time the diagnosis is important as behavioral modification and lifestyle changes in adolescent age group plays an important role for the prevention of future complications and morbidity. 5…”