Polycystic ovary syndrome in adolescents

There is no consensus on what the best diagnostic criteria for polycystic ovary syndrome (PCOS), but in the adolescent the criteria established by the Society of androgen excess and Polycystic Ovary Syndrome (EA-PCOS) in 2009 should be used.

Hyperandrogenism in adolescence is the most reliable symptom of PCOS.

All patients diagnosed with PCOS should be screened for metabolic syndrome, insulin resistance and type 2 diabetes mellitus (DM2).

Changes in lifestyle are essential as part of treatment.

In patients with severe hirsutism or oligomenorrhea long evolution should start treatment except in patients with high risk factors.

Indications of metformin are: obesity is not controlled with changes in lifestyle, oral glucose intolerance or prediabetes, type 2 diabetes, family history of type 2 diabetes and in those patients in whom oral contraceptives are contraindicated.

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Definition and diagnostic criteria

Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women, affecting 5-7% of women of childbearing age. It is characterized by oligomenorrhea and hyperandrogenism, and the appearance of cysts in the ovaries.

Pathophysiology of PCOS

Although the pathophysiology of PCOS is unknown, studies have suggested that involves both genetic and environmental factors causing: impaired release of gonadotropin-releasing hormone, esteroidogénenesis dysregulation, increased androgens and hyperinsulinemia.

Diagnosis of PCOS

The clinical diagnosis is essential to being a medical history and a complete physical examination. Additional tests are focused on differential diagnosis, confirm the SOP and once the diagnosis, to know if there is metabolic syndrome.

Peculiarities of diagnosis of PCOS in adolescents

1. oligomenorrhea: menstrual cycle disturbances in adolescents should be followed in time and if they last or are associated with signs of hyperandrogenism, require a thorough study of suspected SOP. 2. Hyperandrogenism: If a teenager has a very striking hormonal hirsutism study is needed. 3. Polycystic Ovary: it is the least important in the adolescent parameter.

Treatment

SOP management should be individualized according to the patient's risk factors and needs. The change of lifestyle is the treatment that should be recommended to all patients. In patients with severe hirsutism or oligomenorrhea long evolution, initiate treatment with combined oral contraceptives estrogen / progesterone and androgens, except in patients at high risk. Indications of metformin are: obesity is not controlled with changes in lifestyle, oral glucose intolerance or prediabetes, diabetes mellitus type 2 (DM2), family history of type 2 diabetes and in those patients who are contraindicated oral contraceptives.