Moving Beyond Hormones: A Gentler, Smarter Approach to Adolescent PCOS

Dr Suneet Kumar Verma, Dept. of Internal Medicine, Alchemist Hospital, Panchkula, & Sparsh Clinic, Zirakpur, India

Non-hormonal therapies show promise in improving metabolic, menstrual, and androgen-related outcomes in adolescents with PCOS, but stronger adolescent-specific evidence is still urgently needed.

Polycystic ovary syndrome often begins quietly in adolescence, yet its impact can be anything but subtle. Irregular periods, androgen excess, weight gain, and emotional distress frequently intersect at a stage of life already marked by vulnerability. Although combined hormonal contraceptives have long been the mainstay of treatment, their use in teenagers is not without concern. Issues related to side effects, long-term safety, adherence, and cultural acceptance have prompted clinicians to look beyond hormone-based solutions.

Emerging evidence now suggests that non-hormonal therapies may offer meaningful benefits for adolescents with PCOS. A recent systematic review focusing exclusively on girls aged 12–19 years brings welcome clarity to an area dominated by adult data. Metformin, the most studied agent, consistently improved insulin resistance and menstrual regularity, with modest effects on body weight. These changes, though not dramatic, are clinically relevant in a population at high risk of future metabolic disease.

More striking results were seen with combination regimens such as SPIOMET, which target multiple pathways simultaneously. These approaches improved ovulatory function, reduced signs of hyperandrogenism, and favourably influenced metabolic and inflammatory markers, with benefits persisting beyond active treatment.

However, important gaps remain. Evidence for newer agents such as GLP-1 receptor agonists in adolescents is notably absent. As PCOS care evolves, well-designed, adolescent-specific trials are essential to guide safer, more holistic, and patient-centred management strategies—especially for young girls seeking effective care without the burden of hormones.

(Source: Sibal R, Keogh M, Latthe P, Idkowiak J. Non-Hormonal Pharmacological Interventions in Adolescent Polycystic Ovary Syndrome (PCOS): A Systematic Review. Journal of Pediatric and Adolescent Gynecology. 2026 Jan 6. )