Diagnostic criteria of polycystic ovary syndrome in adolescents: a review article
,1 Behnaz enjezab
,2,* Akram ghadiri-anari
1. Student Research Committee, Shahid Sadoughi University of Medical Science
2. Research Center for Nursing and Midwifery Care ,Nursing and Midwifery School, Department of Midwifery, Shahid Sadoughi University of Medical Science
3. Diabetes Research Center, Shahid Sadoughi University of Medical Sciences
Polycystic ovary syndrome is one of the most common hormonal disorders affecting adolescents and adult women. the definition of pcos is still controversial, especially during adolescence. while the prevalence of pcos is given as approximately 7%, it is not easy to estimate the prevalence in adolescents due to the diversity among the experts in this field about the diagnostic criteria and the fact that many symptoms and signs of pcos may overlap with normal puberty. the prevalence of pcos increases rapidly from 12 to 14 years of age, peaks between 15 and 24. pcos is characterized by menstrual irregularity, hyperandrogenism, polycystic ovarian morphology and is also associated with insulin resistance, obesity, and components of the metabolic syndrome. morbidly obese adolescents often have multiple comorbidities. the childhood obesity rate is alarmingly high and identification of pcos and metabolic syndrome as cardiovascular risk factors in childhood should be considered as 77% of overweight children remain overweight as adults. the current epidemic of childhood obesity may increase the severity of symptoms of pcos and underscores the importance of its early and accurate diagnosis. early diagnosis and treatment of pcos is essential to preventing adult disease. the aim of this study was review of diagnostic criteria of polycystic ovary syndrome in adolescents.
From 52 initial obtained articles, 35 articles were reviewed from 2010 to 2018 with the keywords of polycystic ovary syndrome, adolescence, childhood obesity, from resources: pubmed, google scholar, science direct and springer.
In the majority of studies, kind of method was descriptive- correlational study and review articles. all papers had examined different diagnostic criteria among adolescents with pcos, that according to, it has been proposed that at least four of the following five criteria are needed to define adolescent pcos:
oligomenorrhea or amenorrhea 2 years after menarche;(in some studies consecutive menstrual intervals >90 days even in the first year after menstrual onset; and lack of menses by 15 years or 2–3 years after breast budding)
clinical hyperandrogenism: persistent acne unresponsive to topical therapy or moderate to severe hirsutism;
biologic hyperandrogenism: persistent elevation of serum total and/or free testosterone level or increased lh: fsh ratio at the time of menarche; hyperandrogenaemia is thought to be more reliable diagnostic criteria for the diagnosis of adolescent pcos after ruling out other causes of hyperandrogenaemia such as late-onset adrenal hyperplasia and cushing’s syndrome.
insulin resistance/hyperinsulinemia: acanthosis nigricans, abdominal obesity or glucose intolerance;
polycystic ovaries on ultrasound: enlarged ovaries, peripheral microcysts or increased stroma. (some studies believe that ovarian appearance and volume may vary during adolescence and transabdominal ultrasound may be technically limited in overweight and obese individuals.)
although the majority of studies have shown that anti-mullerian hormone may be a useful adjunct in the diagnosis of pcos in adolescents, some studies suggested that amh is not an ideal diagnostic marker due to its higher levels in adolescents and young adult’s patients with pcos and its routine use in clinical practice cannot at present be recommended. furthermore, it’s not a good marker for cardiovascular risk factors in adolescence.
some suggest that even using the strictest criteria, the diagnosis of pcos may not valid in adolescents younger than 18 years.
Until now, there is no validated diagnostic criteria for pcos in adolescents. adolescents with incomplete criteria for a ﬁrm diagnosis of pcos should be followed up carefully and may be diagnosed at a later time. as the incidence of obesity is increasing both in childhood and adolescence, clinicians should focus on weight loss through healthy diet, regular exercise and yoga as an important treatment goal in overweight adolescents and to prevent obesity and its complications in next generations, they should train healthy lifestyle to young adults and new parents.
Polycystic ovary syndrome, adolescence, childhood obesity, diagnostic criteria