{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:05:23Z","timestamp":1792087523961,"version":"4.4.0"},"reference-count":53,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T00:00:00Z","timestamp":1675382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. A diagnosis of PCOS is established when a patient exhibits two of three Rotterdam criteria: oligoovulation or anovulation, excess androgen activity, and polycystic ovarian morphology. The pathogenesis of PCOS, as it affects adolescents, is often discussed in terms of a \u201ctwo-hit\u201d theory. This refers to a stepwise process in which the first \u201chit\u201d is an inborn congenitally programmed predisposition, while the second \u201chit\u201d arises from a provocative factor such as insulin resistance. The dynamic physiological and anatomical changes which occur in puberty make for a challenging diagnosis in this group of patients. It is important to be mindful of the physiological particularities in adolescence which often mimic the symptoms of PCOS. In their first-year post-menarche, approximately 75% of menstruating adolescents report their cycle to last between 21\u201345 days. Recent studies have shown that regular menstrual cyclicity is only achieved within 2\u20133 years post-menarche. Anovulation, as a crucial diagnostic element for PCOS, features in about half of early-post-menarchal adolescents. Hirsutism and acne are the most common clinical manifestations of hyperandrogenism, and mild features are developed by most adolescents as a result of elevated androgen levels. Distinguishing between a pathological sign and normal features of maturation is often difficult. A polycystic ovarian morphology (PCOM) through ultrasound has been found in up to 40%, 35%, and 33.3% of patients when assessed at 2, 3, and 4 years, respectively, after menarche. PCOM in adolescence is not associated with future abnormalities in ovulatory rate or menstrual cycle duration. For this reason, international guidelines recommend against the use of pelvic ultrasound until 8 years post-menarche. The primary aim of management is focused mainly on improving hormonal and metabolic status, the prevention of future comorbid complications, and generally improving the overall quality of life in young women with PCOS. Considerable controversy surrounds the choice of optimal pharmacological treatment to address PCOS in adolescents. Reliable studies, which include this sub-section of the population, are very limited. There is a lack of robust and reliable trials in the literature addressing the use of combined oral contraceptives. Further work needs to be undertaken in order to provide safe and effective care to the adolescent population in this regard.<\/jats:p>","DOI":"10.3390\/jcm12031221","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T03:04:23Z","timestamp":1675393463000},"page":"1221","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["PCOS in Adolescents\u2014Ongoing Riddles in Diagnosis and Treatment"],"prefix":"10.3390","volume":"12","author":[{"given":"Blazej","family":"Meczekalski","sequence":"first","affiliation":[{"name":"Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Niwczyk","sequence":"additional","affiliation":[{"name":"Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Kostrzak","sequence":"additional","affiliation":[{"name":"Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzena","family":"Maciejewska-Jeske","sequence":"additional","affiliation":[{"name":"Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Bala","sequence":"additional","affiliation":[{"name":"UCD School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Szeliga","sequence":"additional","affiliation":[{"name":"Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-535 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,3]]},"reference":[{"key":"ref_1","unstructured":"Leon, L.I.R., Anastasopoulou, C., and Mayrin, J.V. (2022). Encyclopedia of Genetics, Genomics, Proteomics and Informatics, Springer."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1030353","DOI":"10.3389\/fendo.2022.1030353","article-title":"Editorial: Polycystic ovary syndrome (PCOS): Mechanism and management","volume":"13","author":"Wang","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Parker, J., O\u2019brien, C., Hawrelak, J., and Gersh, F.L. (2022). Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19031336"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"86","DOI":"10.4103\/ijpvm.IJPVM_576_17","article-title":"Oxidative Stress and Polycystic Ovary Syndrome: A Brief Review","volume":"10","author":"Mohammadi","year":"2019","journal-title":"Int. J. Prev. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5869","DOI":"10.1002\/fsn3.2523","article-title":"Female infertility and herbal medicine: An overview of the new findings","volume":"9","author":"Akbaribazm","year":"2021","journal-title":"Food Sci. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Giampaolino, P., Foreste, V., Di Filippo, C., Gallo, A., Mercorio, A., Serafino, P., Improda, F.P., Verrazzo, P., Zara, G., and Buonfantino, C. (2021). Microbiome and PCOS: State-of-Art and Future Aspects. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22042048"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Heidarzadehpilehrood, R., Pirhoushiaran, M., Abdollahzadeh, R., Osman, M.B., Sakinah, M., Nordin, N., and Hamid, H.A. (2022). A Review on CYP11A1, CYP17A1, and CYP19A1 Polymorphism Studies: Candidate Susceptibility Genes for Polycystic Ovary Syndrome (PCOS) and Infertility. Genes, 13.","DOI":"10.3390\/genes13020302"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Muccee, F., Bijou, O., Harakeh, S., Adawiyah, R., Sayyed, R.Z., Haghshenas, L., Alshehri, D., Ansari, M.J., and Ghazanfar, S. (2022). In-Silico Investigation of Effects of Single-Nucleotide Polymorphisms in PCOS-Associated CYP11A1 Gene on Mutated Proteins. Genes, 13.","DOI":"10.3390\/genes13071231"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Spritzer, P.M., Marchesan, L.B., Santos, B.R., and Fighera, T.M. (2022). Hirsutism, Normal Androgens and Diagnosis of PCOS. Diagnostics, 12.","DOI":"10.3390\/diagnostics12081922"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Armanini, D., Boscaro, M., Bordin, L., and Sabbadin, C. (2022). Controversies in the Pathogenesis, Diagnosis and Treatment of PCOS: Focus on Insulin Resistance, Inflammation, and Hyperandrogenism. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23084110"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.ecl.2020.10.002","article-title":"Diagnosis of Polycystic Ovary Syndrome: Which Criteria to Use and When?","volume":"50","author":"Chang","year":"2021","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1016\/S0140-6736(88)91612-1","article-title":"Polycystic ovaries--a common finding in normal women","volume":"1","author":"Polson","year":"1988","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.fertnstert.2011.09.024","article-title":"Consensus on women\u2019s health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE\/ASRM-Sponsored 3rd PCOS Consensus Workshop Group","volume":"97","author":"Fauser","year":"2012","journal-title":"Fertil. Steril."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Pe\u00f1a, A., Codner, E., and Witchel, S.C. (2022). riteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review. Diagnostics, 12.","DOI":"10.3390\/diagnostics12081931"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/j.jpag.2021.02.004","article-title":"NoPolycystic Ovarian Morphology in Normocyclic Non-hyperandrogenic Adolescents","volume":"34","author":"Fulghesu","year":"2021","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1159\/000479371","article-title":"An International Consortium Update: Pathophysiology, Diagnosis, and Treatment of Polycystic Ovarian Syndrome in Adolescence","volume":"88","author":"Oberfield","year":"2017","journal-title":"Horm. Res. Paediatr."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Pe\u00f1a, A.S., Witchel, S.F., Hoeger, K.M., Oberfield, S.E., Vogiatzi, M.G., Misso, M., Garad, R., Dabadghao, P., and Teede, H. (2020). Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC Med., 18.","DOI":"10.1186\/s12916-020-01516-x"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"625","DOI":"10.3109\/09513590.2015.1025380","article-title":"Hirsutism and oligomenorrhea are appropriate screening criteria for polycystic ovary syndrome in adolescents","volume":"31","author":"Villarroel","year":"2015","journal-title":"Gynecol. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2339","DOI":"10.1093\/humrep\/deu200","article-title":"Irregular menstruation and hyperandrogenaemia in adolescence are associated with polycystic ovary syndrome and infertility in later life: Northern Finland Birth Cohort 1986 study","volume":"29","author":"West","year":"2014","journal-title":"Hum. Reprod."},{"key":"ref_20","first-page":"1285","article-title":"Diagnosis of the polycystic ovary syndrome in adolescence: Comparison of adolescent and adult hyperandrogenism","volume":"13","author":"Rosenfield","year":"2000","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.jpag.2018.02.126","article-title":"The Diagnostic Value of Anti-M\u00fcllerian Hormone in Early Post Menarche Adolescent Girls with Polycystic Ovarian Syndrome","volume":"31","author":"Kocaay","year":"2018","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.fertnstert.2018.10.020","article-title":"Minimal difference in phenotype between adolescents and young adults with polycystic ovary syndrome","volume":"111","author":"Zore","year":"2019","journal-title":"Fertil. Steril."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2875","DOI":"10.1210\/jc.2018-02548","article-title":"Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee","volume":"104","author":"Carmina","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"E3257","DOI":"10.1210\/clinem\/dgaa355","article-title":"Menstrual Pattern, Reproductive Hormones, and Transabdominal 3D Ultrasound in 317 Adolescent Girls","volume":"105","author":"Assens","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S84","DOI":"10.4103\/2230-8210.140251","article-title":"Onset of menstrual cycle and menses features among secondary school girls in Italy: A questionnaire study on 3,783 students","volume":"18","author":"Bernasconi","year":"2014","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1159\/000375530","article-title":"The Diagnosis of Polycystic Ovary Syndrome during Adolescence","volume":"83","author":"Witchel","year":"2015","journal-title":"Horm. Res. Paediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"E1084","DOI":"10.1210\/clinem\/dgaa949","article-title":"Anti-M\u00fcllerian Hormone Levels in Adolescence in Relation to Long-term Follow-up for Presence of Polycystic Ovary Syndrome","volume":"106","author":"Caanen","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3572","DOI":"10.1210\/jc.2013-1770","article-title":"Clinical review: Adolescent anovulation: Maturational mechanisms and implications","volume":"98","author":"Rosenfield","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.fertnstert.2010.06.015","article-title":"Polycystic ovarian morphology in postmenarchal adolescents","volume":"95","author":"Codner","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kelsey, T.W., Dodwell, S.K., Wilkinson, A.G., Greve, T., Andersen, C.Y., Anderson, R.A., and Wallace, W.H.B. (2013). Ovarian volume throughout life: A validated normative model. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0071465"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.ijgo.2007.02.024","article-title":"Three-dimensional transrectal ultrasonography in adolescent patients with polycystic ovarian syndrome","volume":"98","author":"Sun","year":"2007","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1038\/s41390-019-0615-1","article-title":"Curtailing PCOS","volume":"87","author":"Witchel","year":"2020","journal-title":"Pediatr. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1210\/js.2017-00192","article-title":"Insulin Resistance, Hyperinsulinemia, and Mitochondria Dysfunction in Nonobese Girls with Polycystic Ovarian Syndrome","volume":"1","author":"Rahat","year":"2017","journal-title":"J. Endocr. Soc."},{"key":"ref_34","first-page":"66","article-title":"Glucose intolerance in obese adolescents with polycystic ovary syndrome: Roles of insulin resistance and beta-cell dysfunction and risk of cardiovascular disease","volume":"86","author":"Arslanian","year":"2001","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/j.1399-5448.2012.00902.x","article-title":"Polycystic ovary syndrome in adolescence: Impaired glucose tolerance occurs across the spectrum of BMI","volume":"14","author":"Flannery","year":"2013","journal-title":"Pediatr. Diabetes"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1093\/humrep\/dey256","article-title":"Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"33","author":"Teede","year":"2018","journal-title":"Hum. Reprod."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2809","DOI":"10.1210\/jc.2019-00234","article-title":"Depression Over the Lifespan in a Population-Based Cohort of Women with Polycystic Ovary Syndrome: Longitudinal Analysis","volume":"104","author":"Greenwood","year":"2019","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"984653","DOI":"10.3389\/fpsyt.2022.984653","article-title":"Development and validation of a prediction model for depression in adolescents with polycystic ovary syndrome: A study protocol","volume":"13","author":"Ding","year":"2022","journal-title":"Front. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/j.jpag.2019.07.008","article-title":"Psychiatric Disorders, Self-Esteem, and Quality of Life in Adolescents with Polycystic Ovary Syndrome","volume":"32","year":"2019","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.jpag.2020.08.018","article-title":"Body Perception, Self-Esteem, and Comorbid Psychiatric Disorders in Adolescents Diagnosed with Polycystic Ovary Syndrome","volume":"33","author":"Sari","year":"2020","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1093\/humrep\/dex044","article-title":"High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: A systematic review and meta-analysis","volume":"32","author":"Cooney","year":"2017","journal-title":"Hum. Reprod."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1093\/humrep\/deab181","article-title":"Is fertility reduced in ovulatory women with polycystic ovary syndrome? An opinion paper","volume":"36","author":"Palomba","year":"2021","journal-title":"Hum. Reprod."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1515\/jpem-2022-0249","article-title":"Gender diversity in adolescents with polycystic ovary syndrome","volume":"35","author":"Schweisberger","year":"2022","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1055\/s-0042-1742292","article-title":"Polycystic Ovary Syndrome in Adolescence: Challenges in Diagnosis and Management","volume":"44","author":"Manique","year":"2022","journal-title":"Rev. Bras. Ginecol. Obstet."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Abdolahian, S., Tehrani, F.R., Amiri, M., Ghodsi, D., Yarandi, R.B., Jafari, M., Majd, H.A., and Nahidi, F. (2020). Effect of lifestyle modifications on anthropometric, clinical, and biochemical parameters in adolescent girls with polycystic ovary syndrome: A systematic review and meta-analysis. BMC Endocr. Disord., 20.","DOI":"10.1186\/s12902-020-00552-1"},{"key":"ref_46","first-page":"91554","article-title":"Polycystic Ovary Syndrome in Adolescents: Challenges in Diagnosis and Treatment","volume":"17","author":"Tehrani","year":"2019","journal-title":"Int. J. Endocrinol. Metab."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.4158\/EP15748.DSC","article-title":"American association of clinical endocrinologists, American college of endocrinology, and androgen excess and pcos society disease state clinical review: Guide to the best practices in the evaluation and treatment of polycystic ovary syndrome\u2014Part 1","volume":"21","author":"Goodman","year":"2015","journal-title":"Endocr. Pract."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1080\/09513590.2021.1903419","article-title":"Hyperthecosis: An underestimated nontumorous cause of hyperandrogenism","volume":"37","author":"Meczekalski","year":"2021","journal-title":"Gynecol. Endocrinol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"S210","DOI":"10.1542\/peds.2019-2056J","article-title":"Diagnosis and Management of Polycystic Ovary Syndrome in Adolescents","volume":"145","author":"Trent","year":"2020","journal-title":"Pediatrics"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1473612","DOI":"10.1155\/2016\/1473612","article-title":"Myo-Inositol in the Treatment of Teenagers Affected by PCOS","volume":"2016","author":"Pkhaladze","year":"2016","journal-title":"Int. J. Endocrinol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1097\/MOP.0000000000000636","article-title":"An update on PCOS in adolescents","volume":"30","author":"Fitzgerald","year":"2018","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.jpag.2014.05.005","article-title":"The effect of chromium supplementation on polycystic ovary syndrome in adolescents","volume":"28","author":"Amr","year":"2015","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_53","first-page":"2161","article-title":"Effects of a Combination of Alpha Lipoic Acid and Myo-Inositol on Insulin Dynamics in Overweight\/Obese Patients with PCOS","volume":"3","author":"Despini","year":"2014","journal-title":"Endocrinol. Metab. Syndr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/1221\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:23:08Z","timestamp":1760120588000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/1221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,3]]},"references-count":53,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12031221"],"URL":"https:\/\/doi.org\/10.3390\/jcm12031221","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,3]]}}}