From the Guidelines
No, 8-year-old children typically cannot have polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder that generally develops during or after puberty, usually in the teenage years or early adulthood. The condition involves hormonal imbalances, particularly elevated levels of androgens (male hormones), which affect ovarian function. For PCOS to develop, a girl needs to have begun puberty and have functioning ovaries producing hormones. At age 8, most children have not yet entered puberty, so their reproductive hormones remain at low, pre-pubertal levels.
Key Considerations
- According to the international evidence-based guideline, ultrasound should not be used for the diagnosis of PCOS in those with a gynaecological age of < 8 years (< 8 years after menarche), due to the high incidence of multi-follicular ovaries in this life stage 1.
- If an 8-year-old shows signs of hormonal imbalance, such as early puberty, unusual hair growth, or acne, these symptoms would likely be investigated for other conditions like precocious puberty or adrenal disorders rather than PCOS.
- Parents concerned about hormonal issues in young children should consult a pediatric endocrinologist for proper evaluation and diagnosis.
Diagnostic Challenges
- The diagnosis of PCOS in adolescents can be challenging due to the overlap of symptoms with other conditions, such as thyroid disease, prolactin excess, and nonclassical congenital adrenal hyperplasia 1.
- Hormonal testing and interpretation of testing is complex, and a typical hormone-screening panel includes free and total testosterone, dehydroepiandrosterone sulfate (DHEA-S), androstenedione, luteinizing hormone, and follicle-stimulating hormone 1.
Recommendations
- The new international guidelines recommend against the use of ultrasound in the diagnosis of PCOS until 8 years post menarche 1.
- Age-specific cut-offs for both PCOM and AMH are needed, and the sensitivity, specificity, and area under the ROC curve suggest greater accuracy of AMH in PCOS diagnosis in adults than in adolescents 1.
From the Research
PCOS in 8-Year-Olds
- PCOS (Polycystic Ovary Syndrome) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation, typically affecting reproductive-aged women 2.
- Symptoms of PCOS can arise during early pubertal years, and both normal female pubertal development and PCOS are characterized by irregular menstrual cycles, anovulation, and acne 2.
- Diagnostic features for adolescent girls with PCOS include menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia, and pelvic ultrasound findings are not needed for diagnosis 2, 3.
Risk Factors and Diagnosis
- Premature adrenarche (PA) may increase the risk for PCOS, and girls with PA may have higher prevalence of hirsutism and decreased sex hormone-binding globulin (SHBG) concentrations 4.
- Early pubertal pelvic and breast ultrasonographic changes can be identified in girls with premature pubarche due to adrenarche, and endometrial thickness may be positively associated with serum insulin levels 5.
- Establishing a diagnosis of PCOS is problematic in adolescents, and hyperandrogenism is central to the presentation in adolescents 3.
Management and Treatment
- Management of adolescents with PCOS or at risk for PCOS includes education, healthy lifestyle interventions, and therapeutic interventions targeting symptoms, such as metformin, combined oral contraceptive pills, spironolactone, and local treatments for hirsutism and acne 2, 3.
- Hormonal contraceptives and metformin are treatment options in adolescents with PCOS, and lifestyle intervention is beneficial in overweight/obese patients for other health benefits 3.