From the Guidelines
PCOS can develop as early as the first menstrual period, although it may not be diagnosed until later in life, typically in the teenage years or early twenties. The development of PCOS is a gradual process, resulting from a combination of genetic predisposition and environmental factors that cause insulin resistance and elevated androgen levels 1. According to the Rotterdam criteria, PCOS is defined as the presence of two of three of the following: oligo/anovulation, polycystic ovaries, and clinical or biochemical hyperandrogenism 1.
Key factors that contribute to the development of PCOS include:
- Insulin resistance (IR), which plays a crucial role in many symptoms of PCOS, regardless of body mass index (BMI) 1
- Hyperinsulinemia, resulting from IR, which contributes to hyperandrogenism through effects on the pituitary, liver, and ovaries 1
- Obesity, which exacerbates IR and worsens all symptoms of PCOS 1
The clinical presentation of PCOS may vary, but common symptoms include:
- Irregular periods
- Excess hair growth
- Acne
- Formation of small cysts on the ovaries
Early detection and management of PCOS are crucial to prevent long-term complications and improve quality of life. Lifestyle modifications, such as diet and exercise, can help improve insulin sensitivity and reduce symptoms 1. Additionally, hormonal birth control and medications like metformin may be prescribed to regulate periods and address insulin resistance. Regular medical check-ups are essential for monitoring the condition and adjusting treatment as necessary.
From the Research
Development of PCOS
- PCOS can develop during the early pubertal years, with symptoms arising due to hyperandrogenism and chronic anovulation 2.
- The evolution of PCOS during early adolescence is not well-understood, but seems to involve abnormal activation of the hypothalamic-pituitary-ovarian-adrenal axis accompanied by specific morphologic changes of the ovary 3.
- Daughters of women with PCOS have a greater follicle complement and mild metabolic abnormalities from infancy, and PCOS is often diagnosed in puberty with the onset of hyperandrogenism 4.
Age of Onset
- PCOS can be identified from early infancy to puberty based on predisposing environmental influences, and is often diagnosed in puberty with the onset of hyperandrogenism 4.
- The primary clinical manifestations of PCOS, such as hirsutism and irregular menstrual bleeding, emerge late in puberty or shortly thereafter 3.
- PCOS can develop during adolescence, with clinical features such as hyperandrogenism, menses irregularities, and insulin resistance occurring together 5.
Diagnostic Criteria
- Diagnostic features for adolescent girls with PCOS include menstrual irregularity, clinical hyperandrogenism, and/or hyperandrogenemia, with pelvic ultrasound findings not needed for diagnosis 2.
- The Rotterdam criteria are accepted for adult women, but different diagnostic criteria for PCOS in adolescent girls have been delineated 2.
- Efforts to minimize the clinical features of PCOS in young adolescent girls depend on early diagnosis and timely suppression of excess ovarian androgen production 3.