6 - Management of polycystic ovary syndrome through puberty and adolescence

Summary

Introduction

While polycystic ovary syndrome (PCOS) is a well-established condition in adulthood, there is also evidence that the clinical and biochemical features of PCOS may manifest during puberty and in the immediate years post menarche. In 1980, Yen postulated that the development of PCOS begins during puberty, and proposed that it is linked to increasing insulin resistance and weight gain. Some years later, Siegberg et al. reported oligomenorrhoea in adolescent girls with or without hirsutism associated with increased concentrations of luteinising hormone (LH), testosterone and androstenedione, and others observed associations in adolescents of menstrual irregularities, increased LH, testosterone and androstenedione with multicystic ovaries of increased volume. In the early 1990s, Ibañez and colleagues proposed that PCOS may have its origin during early development and may initially manifest as precocious pubarche even before the onset of pubertal development. While it is clear that PCOS is a real entity in the adolescent population, there is still no clear consensus on diagnostic criteria or management options. In this review, we discuss the issues around the diagnosis and management of PCOS through puberty and adolescence, focusing on specific diagnostic and therapeutic challenges.