Diagnosing Polycystic Ovary Syndrome in Adolescents

Endocrinologists at Hassenfeld Children’s Hospital at NYU Langone are experienced in diagnosing adolescent girls with polycystic ovary syndrome (PCOS), which affects the development and function of the ovaries.

Ovaries produce the hormones estrogen and progesterone. These hormones regulate menstruation and ovulation, in which the ovaries release eggs each month. The ovaries, adrenal glands, and adipose (fat) cells also produce androgens, hormones that are found in higher amounts in men.

Androgens include testosterone, androstendione, and dehydroepiandrosterone-sulfate. In both men and women, these hormones play a role in the onset of puberty and help to maintain bone health and improve kidney, liver, and muscle function.

In PCOS, the body produces excess levels of androgens. This disrupts the normal development and release of eggs from the ovaries.

Risk Factors

Although the cause of PCOS is not completely understood, researchers suspect it may be related to insulin resistance. Insulin is a hormone that helps the body convert sugar into energy. When insulin resistance develops, glucose builds up in the blood—leading to type 2 diabetes—and the body compensates by making more insulin. Excess insulin levels are thought to play a role in increasing the production of androgens.

The biggest risk factor for PCOS is being overweight or obese, especially when fat is concentrated around the abdomen. Fat cells around the abdomen produce hormones and other substances that increase inflammation in the body, which can lead to insulin resistance. PCOS also tends to run in families, suggesting that some people are genetically predisposed to develop the condition.

A girl is at increased risk if her mother has insulin resistance or diabetes. Children with a high birth weight or a low birth weight not due to prematurity are at increased risk for developing PCOS later in life. Some girls who have signs of puberty before age 8 also have a higher risk of PCOS.

Signs and Symptoms

Signs and symptoms of PCOS include irregular or heavy menstrual periods or no period at all. Girls who have ovarian cysts that become enlarged or rupture may have lower abdominal pain.

Many signs and symptoms can be linked to the effects of excess androgens. Some girls have excessive hair growth, known as hirsutism, on the face, neck, chest, and abdomen. PCOS also causes scalp hair thinning, called alopecia, and oily skin or persistent acne. Insulin resistance may lead to weight gain and dark, noncancerous spots on the skin called pseudoacanthosis nigricans.

Adolescents with PCOS who do not ovulate regularly may experience complications during adulthood, such as infertility and a slightly higher risk of endometrial cancer. In addition, most have insulin resistance, which prevents the body from converting blood sugar into energy. Chronically high blood sugar can lead to a variety of conditions, including type 2 diabetes, obesity, hypertension, high cholesterol, and heart disease.

To diagnose PCOS, our specialists conduct a physical exam and perform blood and imaging tests.

Physical Exam

During a physical exam, the doctor measures your daughter’s height and weight and may check the distribution of fat around her abdomen to determine if she is overweight. The doctor may also examine the skin to look for pseudoacanthosis nigricans. He or she checks your daughter’s blood pressure as well.

Your doctor also asks about your teen’s menstrual periods—whether they are irregular, unusually heavy, or absent.

Blood Tests

The doctor may order blood tests to measure androgen and insulin levels, which are higher than normal in women with PCOS. He or she may also measure levels of hormones such as leuteinizing hormone (LH), follicle-stimulating hormone (FSH), and progesterone, which can help to determine if your daughter is ovulating normally.

Blood tests are also used to rule out conditions that can cause symptoms similar to those of PCOS. These conditions include Cushing’s disease, which results from the overproduction of cortisol, called the “stress hormone”; late onset congenital adrenal hyperplasia, which increases the production of male hormones; hyperprolactinemia, which is caused by an overproduction of prolactin, a hormone that stimulates milk production; and hypothyroidism, also known as an underactive thyroid.

Pelvic Ultrasound

Your child’s doctor may recommend a pelvic ultrasound to evaluate the size and appearance of the ovaries. During an ultrasound, the doctor places a device called a transducer on your daughter’s abdomen. The transducer emits sound waves that produce images of the ovaries and surrounding structures.

Our experts use results of these tests to create a customized treatment plan for your daughter. The goals are to reduce symptoms and prevent complications. If necessary, your daughter may be referred to specialists for treatment of type 2 diabetes, hypertension, and other related conditions.