Management of PCOS in Adolescence - Can We Improve Future Fertility by Treating Before and in Adolescence

Abstract

PCOS is a multifunctional disorder with an evolving concept. Various studies have shown that this condition affects 8-13% of women of Reproductive age with 5-15% of them being adolescent girls. The physiological pubertal changes can mask the features of PCOS, hence leading to a challenging and a delayed diagnosis during adolescence mainly due to overlapping of symptoms which are mixed with menstrual irregularities, cosmetic issues and anxiety dominating affected girls. Various causative factors have been implicated to cause PCOS, with interaction between genetics, intrauterine maternal environment, and lifestyle. A strong family history in first degree relatives in addition to epigenetic changes and obesity can influence the early onset of PCOS in adolescents. It is important to achieve a timely diagnosis & appropriate management during adolescence in order to tackle co-morbidities associated with PCOS and ensure a smooth transition to adulthood. Identifying at-risk adolescents can prevent PCOS in future and make patients aware of seeking timely treatment. As the adolescent matures into the phase of life when she would like to have children, she can be efficiently managed with lifestyle changes, oral contraceptive pills, androgens, and insulin sensitizers. Pre and Periconceptual management are of crucial importance in a woman having PCOS, as adverse influences on fetal development can cause diseases in the affected fetus due to epigenetic changes. Maternal factors like under/ over nutrition, obesity and Insulin Resistance can contribute to Impaired fetal nutrition and metabolic dysfunction. Hence correction of maternal insulin resistance and hyperandrogenism is important before conception, stressing the need of correct Nutrition during pregnancy to avoid transmission of PCOS to the fetus. There is an increased risk of PCOS in overweight girls between 7-13 yrs. of age, while being overweight after age 13, further worsens the chance of developing PCOS. Adolescents with BMI > 40 are known to have 23-fold increased risk of developing PCOS. Hence being mindful of weight during childhood and adolescence can go a long way in preventing the onset of PCOS across future generations.