A review published in Best Practice & Research Clinical Obstetrics & Gynaecology has outlined adolescent-specific guidance for diagnosing and managing polycystic ovary syndrome (PCOS), addressing the particular challenges that arise when symptoms overlap with normal pubertal development.
The review, led by Tania Dumont, MD, Division Chief of Paediatric and Adolescent Gynaecology at CHEO in Ottawa, Canada, emphasises that both menstrual irregularities and hyperandrogenism must be present for a PCOS diagnosis in adolescents. Unlike in adults, polycystic ovarian morphology on ultrasound and anti-Müllerian hormone levels are not considered valid diagnostic criteria in this age group. Adolescents presenting with only one diagnostic feature should be classified as “at-risk” and reassessed eight years post-menarche, when diagnostic clarity improves.
Lifestyle interventions are recommended as the first-line management approach, with family involvement highlighted as a key factor in adherence. Combined oral contraceptives are recognised as evidence-based first-line pharmacological therapy for menstrual regulation and androgen-related symptoms such as acne and hirsutism. Metformin may be used off-label for associated insulin resistance, with documented safety in adolescent populations. The authors note an absence of medications specifically approved for PCOS and call for improved prescribing guidelines for this age group.
Regular metabolic screening is recommended given the elevated risk of metabolic complications, though barriers related to time, cost, and accessibility remain. The review also highlights the importance of routine mental health assessment, noting that no adolescent-specific validated tools currently exist and that direct clinical conversation remains the most practical screening approach.
The authors identify several areas requiring further research, including simplified metabolic screening protocols and the role of newer progestin formulations in managing hyperandrogenism.
Published in: Best Practice & Research Clinical Obstetrics & Gynaecology
