Polycystic Ovary Syndrome In Teens: Everything You Need To Know

It is normal for teens to go through physical and behavioral changes during puberty. However, if teens start experiencing irregular periods, they may be suffering from polycystic ovary syndrome (PCOS). PCOS can also commonly manifest in adolescents with excessive hair growth (hirsutism) and obesity-associated acanthosis nigricans before menstrual abnormalities are apparent. As a result, many of these teens have psychiatric disorders like depression and anxiety.¹

What is PCOS, and when does it affect teens?

Polycystic ovary syndrome is a condition that can affect young women and teens. The exact cause of PCOS is unknown. However, there are thought to be intrinsic defects within the ovaries. 

The disease is hallmarked by a higher production of androgens than normal. Onset of PCOS can occur after a female adolescent experiences their first menstrual period. 

What are the signs and symptoms of PCOS in teens?

PCOS presents similarly in both adults and teens. Signs and symptoms include:

• Irregular periods 

• Ovaries with cysts

• Increased body hairs in the arms, chest, or inner thighs (hirsutism)

• Infertility

• Acne

• Patches of dark skin on the neck, breasts, and armpits (acanthosis nigricans)

How to tell if my teenage daughter has PCOS

An evaluation for PCOS is typically recommended for adolescent females if they have either an abnormal degree of hirsutism, acne that is unresponsive to topical therapies, or menstrual abnormalities. However, acanthosis nigricans alongside obesity may be the initial presenting complaints of PCOS in adolescents. 

Only a physician can diagnose PCOS. Ensure that your teen daughter carries a log of her menstrual cycle and symptoms, and encourage her to write down any questions she has for the doctor.

Although the exact cause of PCOS is unknown, the following are seen in the context of the pathophysiology and etiology:

Hormonal imbalance

PCOS commonly presents with hyperandrogenism. Furthermore, alongside hyperandrogenism, abnormal insulin resistance is also seen. The cause of the hyperandrogenism seems to be an intrinsic defect in the ovaries.

Insulin resistance

Insulin regulates blood glucose levels. Insulin resistance means that the body does not process sugar properly. Insulin resistance can ultimately lead to compensatory insulin hypersecretion to maintain normal blood sugar levels. This hyperinsulinemia, in turn, can further promote ovarian androgen secretion as well as sex hormone-binding globulin production from the liver, further exacerbating hyperandrogenemia and signs and symptoms of PCOS.

Genetics

PCOS is inherited as a common complex disorder, meaning it is thought to have a hereditary component. In particular, if a first-degree relative has the condition, a teen's risk of developing PCOS increases. Twin concordance studies put the heritability of PCOS at around 70%.

Diagnosis of PCOS in adolescents

When you suspect your teen has PCOS, consult a gynecologist. The doctor will perform a physical examination to check for the signs of PCOS. Your doctor will also ask her about the family's medical history and take her weight and blood pressure. 

In addition, the teen's doctor will perform a blood test to check hormone levels. The doctor will check her testosterone, hormone precursors, glucose, and cholesterol levels in the blood sample. An ultrasound will also be performed to check the lining of the uterus and examine the ovaries for any cysts. 

A doctor will diagnose someone with PCOS using the 2003 Rotterdam criteria. According to the criteria, the patient is diagnosed with PCOS if they have at least two of the following:

• Cysts on one or both ovaries

• Excess androgen levels in their blood work (hyperandrogenism)

• Infrequent/reduced menstrual bleeding or amenorrhea present for at least two years after menarche (or primary amenorrhea at age 16). Oligo- or anovulation may manifest as menstrual bleeding at intervals of less than 21 days or more than 35 days.

Treating PCOS in teenagers

Lifestyle changes

During PCOS treatment, a doctor recommends lifestyle changes to reduce risk factors of diabetes and cardiovascular disease and help restore ovulation. Weight loss alone (as little as 5%) can help restore ovulation. Furthermore, exercise seems to be beneficial in PCOS separately from weight loss. 

Medications

This is another common treatment option for teens living with PCOS, particularly to combat androgen-dependent signs. 

Some of the common medicines used include the following:

• Oral contraceptives (OCP) are the first-line treatment options for the management of hyperandrogenic features where fertility is not desired. OCPs decrease free testosterone. However, they should not be used before epiphyseal (growth plate) closure, and caution is advised with CV risk factors. 

• Metformin is a drug used to treat diabetes by improving insulin levels. Metformin helps lower blood sugar. It can be used to treat underlying insulin resistance and can help with conception. 

• Antiandrogens are used to block the effect of androgens, which helps control hair growth and acne. 

• Hair removal creams slow hair growth. Other options for treating excess hair growth include waxing, electrolysis, and laser treatment. 

Management of PCOS symptoms in teens

While PCOS can be a scary diagnosis, the condition can be effectively managed. The choice of therapy in adolescence should depend on the patient’s symptoms along with goals and preferences. 

The first-line treatment is usually estrogen-progestin combination oral contraceptives (COCs). However, if hirsutism is not controlled with COC alone, antiandrogen and hair reductive therapies can be added. For the management of obesity, lifestyle modification is the first-line treatment. If there is hyperlipidemia as well as indications of insulin resistance, metformin can be added.

The lowdown

PCOS can disrupt a teen's menstrual cycle causing irregular periods and unwanted hair growth. The best approach to diagnosing PCOS is visiting your doctor to perform a physical exam, blood test, and ultrasound exam. 

Although there is no cure for PCOS, it can be managed to allow the teen to have a great quality of life. It is essential for teens with PCOS to make lifestyle changes to lessen their risk of developing diabetes and high blood pressure. 

Frequently asked questions

Are PCOS cysts harmful? 

When a teen has PCOS, their ovaries typically develop cysts. The cysts are not harmful in and by themselves and do not need to be removed. 

Why should I treat PCOS?

Although treatment is aimed at improving quality of life, thus not medically necessary, you may still wish to discuss your options with a physician, as PCOS in the long term is associated with an increased risk of endometrial cancer, type 2 diabetes, and heart disease. 

Is it normal for my teenage daughter with PCOS to be depressed?

Depression is common in adolescent females with PCOS. You may wish to discuss your concerns with your physician, especially if depression starts affecting your daughter’s day-to-day life.