Síndrome de Ovario Poliquístico en adolescentes

Abstract

Diagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging due to features of normal pubertal development overlap with adult diagnostic criteria. The international evidence-based PCOS guideline aimed to promote accurate and timely diagnosis, to optimize consistent care, and to improve health outcomes for adolescents and women with PCOS. This article is a descriptive review of published data and synthesizes adolescent PCOS guidelines recommendations. Specific criteria to improve diagnostic accuracy and avoid over diagnosis include: 1) Irregular menstrual cycles defined according to years’ post-menarche; > 90 days for any one cycle (> 1-year post-menarche), cycles <21 or>45days (>1 to <3years post-menarche); cycles < 21 or > 35 days (> 3 years post-menarche) and primary amenorrhea by age 15 or>3years post-thelarche. Irregular menstrual cycles (< 1-year post-menarche) represent normal pubertal transition; 2) Hyperandrogenism defined as hirsutism, severe acne and/or biochemical hyperandrogenism confirmed using validated high-quality assays; 3) Pelvic ultrasound not recommended for diagnosis of PCOS within 8years post menarche; and 4) exclusion of other disorders that mimic PCOS. For adolescents who have features of PCOS but do not meet diagnostic criteria an ‘at risk’ label can be considered with appropriate symptomatic treatment and regular re-evaluations. Menstrual cycle re-evaluation can occur over 3years post menarche and where only menstrual irregularity or hyperandrogenism are present initially, evaluation with ultrasound can occur after 8years post menarche. Screening for anxiety and depression is required and assessment of eating disorders warrants consideration. Recommendation of healthy lifestyle interventions to prevent excess weight gain should be recommended. For symptom management there are different options. In conclusion, PCOS is diagnosed in adolescents with otherwise unexplained persistent hyperandrogenic anovulatory symptoms that are inappropriate for age and stage of adolescence. The diagnosis of PCOS has lifelong implications, with increased risk for infertility, metabolic syndrome, type 2 diabetes mellitus, cardiovascular events, and endometrial carcinoma.