Polycystic ovary syndrome in pediatric obesity

Polycystic ovary syndrome (PCOS) is one of the most common menstrual disorders in females (Teede et al., Fertil Steril. 2018;110:364-379). The 2018 International Evidence-Based Guidelines for PCOS now include extensive information on diagnosis and treatment of adolescents with PCOS (Teede et al., Fertil Steril. 2018;110:364-379). The diagnosis of PCOS in adolescents requires oligomenorrhea/amenorrhea and clinical (or laboratory) evidence of hyperandrogenism, along with exclusion of other causes irregular menses and/or hyperandrogenism (Pena. BMC Med 2020;18:72). PCOS, when accompanied by obesity, confers an increased risk for cardiometabolic disease, which can develop in adolescence, and therefore routine screening is recommended. PCOS is also associated with an increased risk for mood disorders, abnormal sleep, and dermatologic abnormalities. Treatment for PCOS should be personalized based on each patient's therapy goals. Therapy for PCOS should always include lifestyle modification and a plan to regulate the endometrium. Beyond that, treatment plans should be personalized, based on the patient's perceived chief complaints. Estrogen therapies can regulate menses and decrease acne, hirsutism, and certain skin disorders. Progesterone therapies can be used to regulate endometrium health. Spironolactone can decrease symptoms of hyperandrogenism. Metformin can treat cardiometabolic disease and has a modest effect on hyperandrogenism. Weight loss therapies should be offered and may become more frequent with the advent of new medications. While PCOS encompasses many aspects of overall health, treatment can be achieved in the primary care setting.