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PCOS or polycystic ovarian syndrome is seen commonly among women in the age group of 15 years to 30 years. It affects 6-18% of adolescent girls and approximately 8-13% of young women worldwide. In India, PCOS is widely present, based on vast diversity and socioeconomic conditions. It can range anywhere from 3.7% to 22.5%.
Clinical presentation, laboratory evaluation, diagnostic criteria, and treatment of PCOS differ between adolescent girls and adult women. Adolescent girls (10 to19 years) pose a challenging situation, due to an overlap of normal pubertal development with adult diagnostic criteria.
PCOS can influence reproductive health, metabolic health, cardiovascular health, and emotional well-being. The implications of PCOS in adolescent girls can extend well into adulthood. They can lead to long-term complications, such as hypertension, type 2 diabetes mellitus, infertility, diabetes during pregnancy, premature labor, recurrent miscarriages, cancer of the endometrium (the lining of the uterus), and psychosocial issues of poor self-esteem, body image issues, depression, anxiety, and eating disorders.
Women with PCOS and the associated complications are suspected to pose an additional risk factor for Covid-19 infection.
Between 1-3 years of onset, if the interval between cycles is less than 21 days or more than 45 days.
Beyond 3 years of onset, if the interval between cycles is less than 21 days or more than 35 days or if there are less than 8 cycles in a year.
Interval duration of more than 3 months for any cycle.
Early identification is possible in adolescent girls with periodic growth monitoring (weight, height, and BMI after 5 years of age), use of growth charts for understanding change in BMI, and an understanding of red flag signs of BMI values, irregularities in menstrual cycles and unusual body hair patterns with or without severe acne.
Timely referral to a specialist, pediatric and adolescent endocrinologist, is a must to prevent long-term morbidities, as mentioned above. Management of PCOS ideally requires a multidisciplinary care team consisting of a pediatrician, pediatric and adolescent endocrinologist, a gynecologist with interest in adolescent health, nutritionist, child and adolescent psychologist, and pediatric dermatologist.
Lifestyle modification plays an important role besides other individually tailored treatment modalities. These adolescent girls may undergo a revisit of diagnosis at a later age, nearly 8 years after the onset of menstrual cycles, to understand its implications in adulthood.