The Symptoms and Diagnosis of PCOS in Adolescent Girls

While it is uncommon for a prepubescent girl to be diagnosed with polycystic ovary syndrome (PCOS), the condition can affect teen girls who have started menstruating. In these instances, PCOS can cause girls to have irregular menstrual periods, heavy periods, and even make periods stop altogether. PCOS symptoms can also include hair growth and acne.

Even still, PCOS diagnoses in adolescents are not often made because irregular menstrual cycles from fluctuating hormones are typical in adolescent girls and other symptoms are simply missed.

Causes and Risk Factors

PCOS is one of the most common endocrine disorders in women. Endocrine disorders result when hormones are too low or too high. They also occur if the body does not respond to hormones the way it is supposed to. 

Doctors don’t know exactly what causes PCOS, but the condition seems to be related to hormonal imbalances (particularly higher levels of androgens) and genetics, which is why it runs in families. Girls who have not yet had their first menstrual period cannot have PCOS.

Precocious Puberty

Precocious puberty—which is diagnosed when a girl has her first period before the age of 8—is of particular interest when considering PCOS in adolescent girls.

A study reported in Fertility and Sterility in 2010 looked at the prevalence of PCOS in young women who had undergone precocious puberty. Researchers found adolescent females who had experienced precocious puberty had an increased risk for developing PCOS.

Symptoms

Some common signs of PCOS include:

• Irregular periods, or too frequent, close together periods, or the absence of periods
• Excess hair on the face or other parts of the body referred to as hirsutism
• Acne and clogged pores on the face and body
• Obesity, weight gain, trouble losing weight, or all three
• Patches of dark skin (particularly on the back of the neck), a condition called acanthosis nigricans
• Thinning of the hair on the head, a condition called alopecia
• High blood pressure, high cholesterol, or diabetes mellitus

You can see why some of these symptoms can be overlooked in a developing female. Acne, for instance, is common for many adolescents with or without PCOS.

Diagnosis

If your daughter begins experiencing symptoms of puberty before age 10 or your adolescent girl begins to experience PCOS symptoms, she should be evaluated by a physician. If a doctor thinks she has PCOS, they may refer her to a gynecologist or endocrinologist who can make a diagnosis. Reaching a diagnosis may involve:

• General health questions
• Questions about her menstrual cycle
• A complete physical examination
• Blood tests to check hormone levels, blood sugar, and lipids (including cholesterol)
• A pelvic ultrasound: Ultrasound uses sound waves to take pictures of the reproductive organs (ovaries and uterus) and bladder. In girls with PCOS, the ovaries may be slightly larger than normal and may have multiple tiny cysts on them.

A diagnosis is made by confirming that two of the following are present:

1. Irregular menstrual cycles (also known as oligo/anovulation)
2. Signs of excess testosterone which includes acne or excess body hair or by bloodwork (also known as hyperandrogenism)
3. Polycystic-appearing ovaries on ultrasound

A full hormonal workup should be performed to determine if there is a condition other than PCOS that could explain the symptoms.

Why Getting Treatment Is Important

While there's no cure for PCOS, it is treatable. Diagnosing PCOS is an important first step because getting treatment reduces the chances of an adolescent developing other serious problems in the future. PCOS can result in:

• Infertility
• Excessive hair growth and acne
• Obesity
• Diabetes
• Heart disease
• High blood pressure
• Abnormal bleeding from the uterus
• Cancer

An open conversation with a doctor about what treatments are best at this stage of a girl's life and moving into the future can help you and your daughter better understand how she can manage her condition—with your help.

A Word From Verywell

Be sure to seek the advice of a medical professional if you suspect something just isn't right with your daughter's periods or if she is experiencing symptoms of early puberty. If you feel as though your concerns are not being heard, consider getting a second opinion.