Understanding PCOS in Adolescents

PCOS is something that I see commonly misunderstood and mismanaged for adolescents. It's crucial that we approach this complex condition with clarity and evidence-based practices to ensure our young patients receive appropriate care.

PCOS is common: This heterogeneous condition impacts 5-10% of biological females of reproductive age.

There's no single test that confirms PCOS: Multiple clinical guidelines published over the years have created confusion and led to inconsistent management approaches across healthcare settings. 

Diagnosis in Adolescents: A collaborative group under the International Consortium of Pediatric Endocrinologists has developed clearer recommendations for diagnosing PCOS in adolescents. The required clinical features include: Irregular menses and/or oligomenorrhea AND Hyperandrogenism (either biochemical (such as elevated testosterone) or clinical (such as acne or hirsutism))

Skip the ultrasound: Ultrasound is not recommended as a diagnostic test for adolescents, as many teens have ovarian cysts as a normal variant. There's significant overlap between normal adolescent ovarian morphology and what we might consider "PCOS morphology."

Context matters: PCOS diagnosis is particularly challenging in adolescents because common diagnostic criteria such as irregular periods, acne, and ovarian cysts are frequently seen in teens without PCOS. We must carefully distinguish between normal adolescent development and pathology.

PCOS affects all body types: This condition impacts individuals regardless of body size, yet diagnosis is often missed in those with smaller bodies due to provider bias and assumptions.

Mental health considerations are essential: Adolescents with PCOS face increased risk of developing eating disorders, along with higher rates of body image concerns, lower self-esteem, and greater body dissatisfaction. These psychological impacts require attention alongside physical symptoms.

Addressing Weight Stigma in PCOS Care: Weight stigma presents a significant barrier to comprehensive PCOS care. When healthcare professionals prioritize weight loss over other aspects of treatment, such as managing symptoms, balancing hormones, or addressing broader health concerns,  we do a disservice to our patients and may miss opportunities for more effective interventions.

Moving Forward: Understanding PCOS in adolescents requires a nuanced approach that considers both the unique aspects of adolescent development and the complex, individualized nature of this syndrome. By focusing on evidence-based diagnostic criteria and comprehensive care that addresses both physical and psychological well-being, we can better serve our young patients with PCOS.