Understanding PCOS in Adolescents
What is PCOS?
Polycystic ovary syndrome (PCOS) affects around 1 in 10 women of reproductive age. It is a hormonal condition linked to irregular ovulation, higher levels of “male hormones” (androgens), and sometimes ovaries that look different on ultrasound. In teenagers, PCOS can cause symptoms like irregular or absent periods, acne, oily skin, unwanted hair growth (hirsutism), or sometimes weight gain.
But here’s the key point: many of these changes are normal in puberty. That’s why PCOS is harder to diagnose in adolescence, and why doctors must take a careful, step-by-step approach.
How is PCOS Diagnosed in Teens?
The 2023 international guidelines stress that ultrasound and AMH blood tests should not be used in adolescents, because ovaries are naturally busy with follicles in the years after starting periods. Instead, both of the following are required:
Irregular or absent periods (more than 2 years after starting periods)
Signs of excess androgens, either acne/hirsutism or confirmed on blood tests
Doctors will also check for other possible causes of symptoms before confirming PCOS. Sometimes, if it’s not clear, a young person may be labelled as “at risk of PCOS” and reviewed later.
Why Does PCOS Happen?
PCOS is partly genetic and often runs in families. Insulin resistance — when the body’s cells don’t respond properly to insulin — plays a big role, and this is why PCOS is more severe in some ethnic groups (such as South Asian girls). Lifestyle factors like diet, physical activity, and weight also influence how strongly symptoms appear.
Health Impacts Beyond Periods
PCOS in adolescence isn’t just about periods. It can affect:
Skin and hair – acne, oily skin, extra hair growth, sometimes scalp hair thinning
Fertility in later life – some young women may need help to ovulate, though many conceive naturally
Metabolic health – higher risk of type 2 diabetes, high cholesterol, and high blood pressure later on
Mental health – higher rates of anxiety, depression, body image issues, and eating disorders
Treatment Options for Adolescents
Treatment is tailored to a teenager’s symptoms and goals:
Lifestyle support: healthy eating, movement, and sleep are first-line, focusing on overall wellbeing not weight alone. Even small improvements can help regulate periods and reduce androgen effects.
The pill (COCP): combined oral contraceptives are usually first-line for irregular periods and excess hair/acne, with low-dose options preferred.
Metformin: may be offered for irregular cycles or signs of insulin resistance, especially if lifestyle measures aren’t enough.
Skin treatments: acne may also need dermatology input; hair growth can sometimes be managed with laser.
Mental health support: screening for anxiety, depression, and eating issues is recommended, with referrals when needed.
Reassurance for Teens and Parents
PCOS doesn’t always mean infertility, diabetes, or lifelong problems. With the right support, teenagers with PCOS can live healthy lives, and many of the risks can be reduced. Early diagnosis helps young women understand their bodies, prevent complications, and feel more in control.
When to See a Doctor
If periods are still irregular more than 2 years after they start
If acne is severe or not responding to usual treatment
If there is troubling hair growth on the face, chest, or stomach
If there are concerns about weight, mood, or eating habits
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Yes, in the first 2 years after starting periods it’s common to have irregular cycles. But if irregularity continues, PCOS should be considered.
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No — ultrasound and AMH are not reliable in teenagers, so doctors focus on symptoms and blood tests
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No. Many women with PCOS conceive naturally, though some need help with ovulation later on.
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Not always. Healthy lifestyle is recommended for everyone, regardless of weight. Focus is on overall health and prevention of complications.
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Symptoms can change with age. Some improve, others shift (for example, skin problems may improve but fertility issues may appear later).