Diagnosing and treating PCOS in adolescents

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On March 15, 2023, methods of early diagnosis and treatment for polycystic ovarian syndrome (PCOS) in adolescents were presented at the 44th National Conference on Pediatric Health Care.

The research was presented by Danielle R. Stratton, DNP, RN, PPCNP-BC. According to Stratton, while the exact etiology of PCOS is unknown, there is a link between the condition and unnaturally high androgen levels. Children can also develop PCOS from both parents, not just their mothers.

PCOS is a hormonal disorder that presents through enlarged ovaries with small cysts and may be caused by both genetic and environmental factors. About 12% of women in the United States and 20% of women worldwide are afflicted with PCOS.

Signs of PCOS include missed or irregular periods, weight gain, large ovaries or ovaries with many cysts, acne or oily skin, skin tags, acanthosis nigricans, hirsutism, hair thinning, and infertility. Women with PCOS are at a greater risk of being overweight and insulin-resistant, having sleep apnea, hypertension, heart disease, stroke, depression, anxiety, and hypercholesterolemia.

Stratton noted patients are born with PCOS, but symptoms begin developing during puberty. PCOS diagnosis can be done through multiple methods, with no single “best” test. A strong family history should be collected, along with a thorough medical history, presenting symptoms history, and menstrual cycle history.

A physical examination focused on the pelvic region should also occur. Doctors should also collect an ultrasound and blood lab work, and at least 2 of the 3 official criteria must be met. These criteria include ovulatory dysfunction, hyperandrogenism, and excessive presence of small follicles in or on the ovaries.

Pelvic and transvaginal ultrasounds should be collected and analyzed for swollen ovaries. The hallmark presentation should also be analyzed for an excessive number of follicles.

A PCOS blood lab workup should also be collected, with additional blood lab work collected in overweight or obese patients. According to Stratton, many PCOS patients are overweight or obese, but not all of them.

Treatment methods for PCOS include early administration of medications such as metformin, oral contraceptives, and spironolactone. Metformin is given in doses of 1000 mg to 1500 mg per day and has been found to improve PCOS symptoms and insulin resistance, along with leading to weight loss over time.

Spironolactone helps block the effects of androgens, decreases testosterone production, lowers blood pressure, and sometimes leads to weight loss in obese or overweight patients. It could take up to 6 months for patients to see positive results and improvement.

Doctors should also help empower female adolescents to be proactive about their health, find a balance between hydration and nutrition, get proper sleep, use little to no caffeine, be more physically active, take supplements, manage stress and self-care, and maintain long-term self-adherence to healthy habits from a young age.

Regular physician and gynecological examinations are needed for female adolescents with PCOS, including routine blood lab work and blood pressure checks. A referral to an endocrinologist knowledgeable in PCOS maintenance should be found early for these patients.

Reference

Stratton DR. Adolescent health: PCOS and the importance of early detection, diagnosis, treatment and intervention. Presented at: 44th National Conference on Pediatric Health Care. March 15-19, Orlando, Florida.