Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls

Abstract

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation. Depending on diagnostic criteria, 6% to 20% of reproductive aged women are affected. Symptoms of PCOS arise during the early pubertal years. Both normal female pubertal development and PCOS are characterized by irregular menstrual cycles, anovulation, and acne. Owing to the complicated interwoven pathophysiology, discerning the inciting causes is challenging. Most available clinical data communicate findings and outcomes in adult women. Whereas the Rotterdam criteria are accepted for adult women, different diagnostic criteria for PCOS in adolescent girls have been delineated. Diagnostic features for adolescent girls are menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia. Pelvic ultrasound findings are not needed for the diagnosis of PCOS in adolescent girls. Even before definitive diagnosis of PCOS, adolescents with clinical signs of androgen excess and oligomenorrhea/amenorrhea, features of PCOS, can be regarded as being “at risk for PCOS.” Management of both those at risk for PCOS and those with a confirmed PCOS diagnosis includes education, healthy lifestyle interventions, and therapeutic interventions targeting their symptoms. Interventions can include metformin, combined oral contraceptive pills, spironolactone, and local treatments for hirsutism and acne. In addition to ascertaining for associated comorbidities, management should also include regular follow-up visits and planned transition to adult care providers. Comprehensive knowledge regarding the pathogenesis of PCOS will enable earlier identification of girls with high propensity to develop PCOS. Timely implementation of individualized therapeutic interventions will improve overall management of PCOS during adolescence, prevent associated comorbidities, and improve quality of life.

Effect of lifestyle modifications on anthropometric, clinical, and biochemical parameters in adolescent girls with polycystic ovary syndrome: a systematic review and meta-analysis

“…However, some guidelines have recommended that physical activity of longer duration, higher frequency, and intensity result in better maintenance of health. Importantly, moderate to vigorous daily physical activity for at least 60 min is related to better physical and psychosocial health in children and adolescents [66]. Although the low-glycemic diet in PCOS is recommended [46], international guidelines have demonstrated that there is limited evidence as to which specific energy equivalent diet type is better [67].…”

Fundamental Concepts and Novel Aspects of Polycystic Ovarian Syndrome: Expert Consensus Resolutions

“…Finally, IR, independently from the extent of obesity and magnitude of androgen concentrations, may be present even in lean PCOS. However, transient hyperinsulinemia is typical at puberty and may amplify the individual predisposition to develop PCOS (92).…”

Naturally Occurring and Experimentally Induced Rhesus Macaque Models for Polycystic Ovary Syndrome: Translational Gateways to Clinical Application

“…Peripubertal daughters of PCOS women similarly exhibit elevated AMH levels [18,33], in addition to increased circulating LH levels [18], potentially from accelerated hypothalamic gonadotropin-releasing hormone (GnRH) pulsatile release (a trait programmed in rhesus macaques by gestational T exposure or prepubertal androgen excess [34,35]), and increased proclivity for synthesizing the highly biopotent androgen, dihydrotestosterone (DHT) [36], suggesting enhanced androgen action within target tissues. Not surprisingly, therefore, a major goal of pediatric medicine includes identifying girls at risk of PCOS from reliable prepubertal characteristics [37], in order to initiate early preventive therapy and/or treatment [37,38].…”