Polycystic Ovary Syndrome (PCOS) in Adolescents

Polycystic Ovary Syndrome (PCOS) or polycystic ovary syndrome is a hormonal disorder that most often occurs in adolescent women and women of childbearing age in the world. The incidence of PCOS varies between 1.8% and 15% depending on ethnicity, background and diagnostic criteria used. The clinical manifestations that arise can vary.

Basically, According to a PCOS Specialist in Lahore, PCOS is characterized by menstrual cycle disorders, the level of androgen hormones (male hormones) in a woman increases, this is indicated by clinical symptoms or assessed by laboratory data and the shape of the egg cells such as the appearance of small cysts on an ultrasound examination.

Several Types of Disorders

Adolescent women with PCOS are at risk of experiencing impaired quality of life including menstrual cycle disorders, fertility disorders, psychological and behavioral disorders including depression, bipolar disorder, anxiety and eating disorders. In addition, metabolic disorders are strongly associated with an increased risk of clinical metabolic syndrome, such as obesity and diabetes. Although PCOS cannot be completely cured, there are several treatment options that can help reduce the symptoms of the disease. Most teenage women with PCOS can live normally without significant complications.

PCOS is considered an ovulation and infertility problem, characterized by irregular menstruation, obesity, impaired insulin function, hirsutism, acne, alopecia, and recurrent miscarriages.

Risk Factors and Causes

The cause of PCOS is not yet known for certain. The primary theory of metabolic disorders shows that compensation for impaired insulin function due to excessive levels of the insulin hormone is the main cause of the PCOS picture. Some other causes of PCOS are as follows: genetic susceptibility, hormonal imbalance and contraceptive pills.

Genetic and environmental factors

Genetic and environmental factors (e.g. socioeconomic status, lifestyle) contribute to ethnic variance in PCOS and are also important to consider in developing individualized strategies for treating PCOS. In women with PCOS, multiple small follicles (tiny cysts 4 to 9 mm in diameter) accumulate in the ovaries, hence the name polycystic ovaries. None of these tiny follicles are able to grow to a size that will trigger ovulation. As a result, estrogen, progesterone, LH, and FSH levels become unbalanced. Androgens may be elevated in women with PCOS due to the high LH levels and also insulin levels typically seen in patients with PCOS.

Clinical Symptoms

Signs and symptoms of PCOS usually start around puberty, although some women don’t experience symptoms until late adolescence or even early adulthood. Symptoms that are often experienced by teenage PCOS patients are disruption of the menstrual cycle and symptoms due to increased levels of androgen hormones (male hormones). Irregular menstrual cycles or even menstrual periods that do not come at all (amenorrhea) are often found in adolescent patients with PCOS.

Irregular Menstrual Cycle

This irregular cycle is a sign that ovulation does not occur in each cycle. If ovulation does not occur, the lining of the uterus (called the endometrium) becomes thicker and may shed irregularly, which can cause profuse and prolonged bleeding. Irregular menstrual periods or no periods at all can increase a woman’s risk of endometrial overgrowth (called endometrial hyperplasia) or even endometrial cancer. The following description of menstrual disorders indicates an abnormal menstrual period in adolescents:

  1. Primary amenorrhea: No menstruation until age 15 years (or at bone age 15 years, if there are signs of early puberty) or more than three years after breast development.
  2. Secondary amenorrhea: A condition where there is more than 90 days without a menstrual period, after the previous menstruation.
  3. Oligo menorrhea: During the five years after menarche (first menstruation), oligomenorrhea is defined as:
  4. First year after menarche: Less than four yearly periods (average cycle length of more than 90 days between menstrual periods).
  5. Second year after menarche: Less than six yearly periods (average cycle length more than 60 days).
  6. Third to fifth year after menarche: Less than eight periods per year, i.e. missing more than four periods per year (average cycle length more than 45 days).

Dysfunctional Uterine Bleeding

It is defined as menstrual bleeding that occurs less than 21 days between cycles or bleeding that occurs more than 7 days per menstrual cycle. Because hormonal changes vary from woman to woman, patients with PCOS may have mild to severe acne, facial hair growth, or scalp hair loss. Acne is a skin condition caused by oily skin and blockage of hair follicles.

Severity of Acne

Excessive acne is a form of skin symptom caused by high levels of the androgen hormone in teenage women. The severity of acne can be assessed based on the number of lesions, the presence of moderate lesions (>10 facial lesions), or severe inflammatory acne over the years around the age of menarche. There is a consensus that moderate to severe inflamed acne that is less responsive to treatment is an indication for testing androgen hormone levels. Male pattern hair growth (hirsutism) can be seen on the upper lip, chin, neck, sideburn area, chest, upper or lower abdomen, upper arms, and inner thighs.

Severity of Hirsutism

The severity of hirsutism is assessed based on the Ferryman-Gallwey system which measures the level of hair growth in areas most sensitive to androgen hormones. Hirsutism is defined as a score of 8 or more in the adult female population in the United States and depending on ethnicity in the rest of the population.


The choice of therapy for PCOS Treatment Pakistan in adolescence depends on the symptoms that appear in each adolescent and the goals of the therapy. So the treatment is to treat acne complaints, abnormal menstrual periods, or complaints related to hirsutism.  Treatment options for acne complaints can be treated with medication given through the skin such as antibiotics, oral administration of a combination of estrogen and progesterone hormone preparations (which can also regulate the menstrual cycle), or spironolactone pills which can block the androgen hormone that causes acne.

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