Managing Adolescent PCOS: Challenges Stemming from High Prevalence of Metabolic Complications

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting 5–10% of women worldwide. Characterized by menstrual irregularities, hyperandrogenism, and polycystic ovarian morphology, it impacts multiple domains of health—reproductive, metabolic, cosmetic, and psychological. Early diagnosis and intervention are crucial to prevent long-term complications such as type 2 diabetes and cardiovascular disease.

A recent study conducted at Holly Lab Hospital & Missionary Hospital in Brahmanbaria, Bangladesh, examined the diagnostic approaches and treatment strategies for managing PCOS in adolescents. The study spanned one year (January–December 2023) and included 107 female adolescents aged 10–19 years who met clinical and biochemical criteria for hyperandrogenism and persistent menstrual irregularities, excluding those with underlying medical conditions or ongoing treatments. Data were collected through structured interviews, and statistical analyses were performed using SPSS, with logistic regression applied to identify risk factors for metabolic syndrome.

The majority of participants (55.14%) were aged 10–15 years, with a mean age of 16.8 years. A high prevalence of metabolic complications was observed: 29.7% were overweight and 39.4% were obese. Abdominal obesity was present in 76.6% of participants. Additionally, 20% were pre-hypertensive and 3.4% had hypertension. Glycemic assessments showed 76% were normoglycemic, 21.1% prediabetic, and 2.9% diabetic. Dyslipidemia was detected in 90.9% of the cohort, and metabolic syndrome was diagnosed in 42.3%. Biochemical hyperandrogenism was present in 33.7% of cases.

Clinically, hirsutism (94.9%) and oligomenorrhea (87.85%) were the most common features, and a variety of ovarian morphology patterns were noted. Key diagnostic indicators included hyperandrogenism, ovulatory dysfunction, polycystic ovarian morphology, and metabolic parameters.

Treatment modalities varied among participants: classical pharmacologic interventions (34.58%), lifestyle modifications (14.95%), combined oral contraceptives (12.15%), and anti-androgens (7.48%). Additionally, supplements such as N-acetylcysteine, inositol, vitamin D, and chromium were used as adjunct therapies.

The study concluded that adolescent PCOS management is complex due to the high burden of metabolic complications and the diagnostic ambiguity inherent to this age group. Accurate diagnosis is critical to avoid premature labeling, which may cause psychological distress. A multidisciplinary approach—combining lifestyle interventions, hormonal therapy, and individualized care—is essential. Early diagnosis, standardized diagnostic criteria, and ongoing monitoring are vital to mitigating long-term risks. The study also emphasizes the need for further research across diverse populations to inform culturally appropriate and effective treatment strategies.

Source: Akhter F, Siddiqua A. Sch Int J Obstet Gynec. 2024;7(2):64-9.

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