From the Guidelines
Yes, children can develop Polycystic Ovary Syndrome (PCOS), though it typically begins during or after puberty, usually in adolescence. PCOS in children often manifests with symptoms like irregular periods, excess hair growth, acne, and weight gain. Diagnosis involves blood tests to check hormone levels, ultrasound to examine the ovaries, and evaluation of symptoms. According to the standards of medical care in diabetes-2019 1, evaluation for polycystic ovary syndrome in female adolescents with type 2 diabetes, including laboratory studies when indicated, is recommended.
Diagnosis and Treatment
Treatment for children with PCOS focuses on lifestyle modifications including regular physical activity and a balanced diet to maintain healthy weight. In some cases, medications may be prescribed, such as birth control pills to regulate periods and reduce androgen levels, or metformin to improve insulin sensitivity, as metformin in addition to lifestyle modification is likely to improve the menstrual cyclicity and hyperandrogenism in girls with type 2 diabetes 1. The use of oral contraceptive pills for treatment of polycystic ovary syndrome is not contraindicated for girls with type 2 diabetes 1.
Importance of Early Diagnosis
Early diagnosis and management are important as PCOS can affect long-term health, potentially leading to issues like insulin resistance, type 2 diabetes, and fertility problems later in life. The condition develops due to hormonal imbalances, particularly elevated levels of androgens (male hormones) and insulin resistance, which can be influenced by genetic factors and environmental conditions. The diagnosis of PCOS requires additional clinical criteria beyond imaging findings, as noted in the acr appropriateness criteria® female infertility 1.
Key Considerations
Key considerations in the diagnosis and management of PCOS in children include:
- Evaluation of symptoms and laboratory studies to confirm the diagnosis
- Lifestyle modifications to maintain a healthy weight and improve insulin sensitivity
- Potential use of medications such as birth control pills or metformin to regulate periods and improve symptoms
- Long-term monitoring and management to prevent potential complications such as insulin resistance and fertility problems.
From the Research
Can a Child Have PCOS
- PCOS (Polycystic Ovary Syndrome) is a heterogeneous disorder characterized by hyperandrogenism and chronic anovulation, and its symptoms can arise during the early pubertal years 2.
- The diagnostic features for adolescent girls with PCOS include menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia, and pelvic ultrasound findings are not needed for the diagnosis of PCOS in adolescent girls 2.
- Adolescents with clinical signs of androgen excess and oligomenorrhea/amenorrhea, features of PCOS, can be regarded as being "at risk for PCOS" and can be managed with education, healthy lifestyle interventions, and therapeutic interventions targeting their symptoms 2.
- Management of PCOS in adolescents may include interventions such as metformin, combined oral contraceptive pills, spironolactone, and local treatments for hirsutism and acne 2, 3, 4, 5, 6.
- Comprehensive knowledge regarding the pathogenesis of PCOS will enable earlier identification of girls with high propensity to develop PCOS, and timely implementation of individualized therapeutic interventions will improve overall management of PCOS during adolescence, prevent associated comorbidities, and improve quality of life 2.
Treatment Options for PCOS in Children
- Metformin and spironolactone are commonly used in the treatment of PCOS, and their combination may result in better outcomes 3, 4, 6.
- Metformin has been shown to decrease insulin resistance and improve hirsutism in women with PCOS 5.
- Spironolactone has been shown to reduce clinical and biochemical hyperandrogenism in women with PCOS 4.
- The combination of metformin and spironolactone may be more effective in reducing BMI and serum androgen levels, and improving insulin resistance, than metformin alone 6.