PCOS in Adolescents

Journal Watch:

Polycystic ovary syndrome in adolescence - a therapeutic conundrum
Homburg and Lambalk
Hum. Reprod. (2004) 19 (5): 1039-1042.
doi: 10.1093/humrep/deh207
First published online: March 11, 2004

• The early diagnostic signs of PCOS are often attributed to the physiological changes of adolescence, thereby delaying diagnosis. Early diagnosis would help prevent and control the sequelae of PCOS.
• Adoloscents with oligomenorrhoea (infrequent periods) that does not correct itself & persists 2 years after menarche (onset of menstrual cycles) should be investigated for early features of PCOS.
• Acne is common in teenagers; when very severe/persistent/late onset, one must investigate for PCOS.
• Premature pubarche (appearance of pubic hair) is considered the earliest recognized sign of PCOS.
• Elevated levels of Insulin and DHEAS with premature pubarche indicate a High Risk for PCOS.
• PCOS in adolescents is a clinical diagnosis as biochemical parameters are often normal. Lab results thus should not be solely relied upon and should be used to rule out other conditions.
• In obese adolescents, the early presence of Insulin Resistance and Impaired Glucose Tolerance indicate a need for lifestyle interventions. Fasting Lipids and two hour glucose challenge should be tested periodically in these individuals. Weight loss is a primary & essential part of their treatment plan.
• A fasting glucose to insulin ratio of less than 7 indicates Insulin Resistance in adolescents.
• Antiandrogens are excellent for the management of acne and hirsutism when used with cyclical OCPs.
• Results are seen after 4-9 months of treatment in hirsutism and after 3-5 months in acne patients.
• With combined use of OCPs and antiandrogens about 60% patients could be expected to be acne free in six months and about 95% to be acne free in twelve months of starting treatment.
• A longer treatment with antiandrogens, while managing adverse effects, may reduce risk of relapse.
• Untreated PCOS is usually a progressive syndrome at least until the age of forty years.
• The use of cyclical Ethinyl Estradiol with Cyproterone Acetate may put the progression of PCOS on hold and also increase the chances of conception when the medication is stopped.
• Central obesity exacerbates Insulin Resistance.
• The first line of treatment for PCOS and especially in adolescents, is weight loss, if overweight/obese.
• Maintenance of a normal body weight is as effective as Metformin for treating Hyperinsulinemia.