Frequency of Polycystic Ovary Syndrome and “Being at Risk for Polycystic Ovary Syndrome” in Obese Adolescent Girls in Light of Current Definitions

Objective: Obesity is associated with an increased risk of polycystic ovary syndrome (PCOS). It can be difficult to differentiate between PCOS and physiological oligomenorrhoea/anovulation in adolescent girls. To date, studies of the prevalence of PCOS in adolescents have predominantly used diagnostic criteria validated primarily in adult women. The aim of this study was to investigate the prevalence of PCOS in obese girls using the current diagnostic criteria for adolescents. Methods: The diagnosis of PCOS was based on the presence of menstrual irregularity, clinical hyperandrogenism and hyperandrogenemia and the exclusion of other causes. Patients with one or two of these conditions were classified as “at risk for PCOS”. The control group consisted of patients with obesity alone but no other comorbidity. Results: A total of 421 patients were included in the study. The number of patients meeting the definition of PCOS was 35, representing a prevalence of 8.3%, while 200 patients (46%) were defined as “at risk for PCOS”. The diagnostic value of the free androgen index (FAI) was found to be adequate, while other tests were poor. The cut-off values were 11 for FAI and 0.44 ng/mL for total testosterone, with optimal sensitivity and specificity. Conclusion: Despite the increasing number of studies, the diagnosis and management of PCOS in adolescents remains challenging. While efforts should be made to avoid overdiagnosis, it is also important to recognize that many more patients may be at risk of developing PCOS.