What is PCOS?
Polycystic Ovarian Syndrome (PCOS) is a hormone imbalance that leads to higher-than-normal levels of the male testosterone (male reproductive hormone) in females. PCOS is quite common and affects 6-10% of girls and women worldwide.
Hormone abnormalities and higher testosterone levels from PCOS may lead your child to experience irregular periods and skin changes, and have insulin resistance, a risk factor for diabetes. Girls and women with PCOS have a higher risk of diabetes and other metabolic disorders.
Weight gain can be associated with PCOS in some patients, but normal weight or underweight girls can also have PCOS. Adult women with PCOS, may have larger ovaries (with no cysts present) or have more egg follicles. Ovaries in teens with PCOS may appear normal.
Causes of PCOS
There is no clear cause of PCOS, but there is increased risk in certain conditions:
- A family history of PCOS
- A hormonal imbalance while your child was in the womb
- Early puberty in childhood
- Excess body weight
Signs and symptoms of PCOS
Reproductive issues
For teens, PCOS results in irregular periods, which is a sign of irregular egg release (ovulation). This can show up as:
- Infrequent periods (fewer than 8 per year)
- Periods stopping altogether
- Never having a period, despite other pubertal development
- Excess bleeding (this is rare)
In adulthood, PCOS can:
- Increase the risk of uterine cancer if left untreated
- Create difficulty getting pregnant (infertility), though this can be treated
Skin issues
Because of higher testosterone levels, your child may experience skin issues, including:
- Pimples (acne)
- Excess facial or body hair
- Scalp hair loss or hair thinning
- Painful swollen areas (boils), often appearing in the underarms, breast and groin (hidradenitis suppurativa)
Metabolic issues
PCOS is strongly associated with metabolic issues, including:
- Prediabetes or type 2 diabetes
- High blood pressure
- High cholesterol
- Fat deposition in the liver (metabolic dysfunction-associated steatotic liver disease)
Psychological concerns
We are finding that girls with PCOS have increased rates of psychological concerns such as:
- Depression
- Anxiety
- Disordered eating and body image
Testing and diagnosis for PCOS
Our PCOS Clinic offers physical exams, laboratory testing, nutritional counseling and other family-centered services to help diagnose and treat PCOS. To diagnose your child with PCOS, we require blood tests showing high testosterone levels, but otherwise normal levels of hormones from the pituitary, thyroid and adrenal glands. In rare cases, we may perform ultrasounds to look for visible issues in the uterus, ovaries or adrenal glands.
Treatment for PCOS
Treatment for PCOS is a combination of lifestyle changes (diet, exercise, skin care) and medications for regulating periods, treating metabolic disorders and managing skin conditions.
Medication options for regulating periods or maintaining uterine health include:
- Hormone (estrogen-progesterone) pills or patches
- Progesterone only pills
- Hormonal implants or an object placed inside the uterus (intra-uterine device)
Options for lowering insulin resistance or treating metabolic concerns include:
- Changes in diet and increased exercise
- Medicine to control the amount of sugar in your child’s blood (metformin), which makes their body more sensitive to insulin
- Weight loss medications
- Weight loss (bariatric) surgery
For skin concerns, options include:
- Estrogen-progesterone pills or patches, which lower testosterone and decrease acne or excess hair
- Medications that can be applied to the skin or taken by mouth to block male hormones in the body (anti-androgen therapies), or a pill to help treat acne, excess hair or hair loss/hair thinning (spironolactone)
- Acne medications that can be applied to the skin or taken by mouth
- Antibiotics, applied to the skin or taken by mouth, to treat painful lumps (hidradenitis suppurativa) your child may experience
- Laser hair removal for excess hair
Follow-up care for PCOS
Your child with PCOS will require regular follow up and monitoring to assess the pattern of periods and skin changes, and to screen for diabetes, high blood pressure, high cholesterol and other concerns. Our PCOS clinic has providers in endocrinology, dermatology and nutrition who provide comprehensive, compassionate medical care.
While many aspects of PCOS are managed by an endocrinologist or adolescent medicine specialist, select patients may need additional care from our experienced clinic specialists, including a dermatologist, registered dietician, or experts from our weight management/bariatric surgery program. If your child needs mental health support, we can refer them to a behavioral health expert (such as a psychologist, psychiatrist or therapist).
Your child's unique care plan is created collaboratively, so medicines and therapies complement each other.
Long-term outlook for children with PCOS
While there is no cure for PCOS, adequate treatment can improve your child’s health, with no impact on school or other activities. As they grow into adulthood, girls and women with PCOS should be managed closely by a gynecologist and may need to see an endocrinologist or other specialist. Most women with PCOS can achieve and carry healthy pregnancies but may require medical interventions and closer monitoring during this time.
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Reviewed by Rachana D. Shah, MD