PCOS: Differences between teens and adults

Polycystic ovarian syndrome (PCOS), a hormonal condition that affects an estimated one in 10 women, has a wide array of symptoms and is often underdiagnosed.

The variety of symptoms means that not everyone experiences PCOS in the same way. Diagnosis and treatment approaches also differ for teens and adults, which can make it more confusing. Plus, social media adds to the confusion, touting miracle “cures,” special diets and supplements.

But understanding what PCOS is and how treatment is approached — especially in adolescents versus adults — can help clear up misconceptions.

What is PCOS?

Polycystic ovarian syndrome happens when the ovaries produce higher-than-normal levels of a particular type of hormone called androgens (testosterone is a type of androgen). These elevated levels can interfere with regular ovulation.

Common signs of PCOS include:

• Irregular periods (skipping periods, no periods at all or periods that are too frequent)
• Abnormal bleeding
• Excess hair on the face or other parts of the body, called hirsutism
• Acne
• Weight gain or trouble losing weight

How PCOS is diagnosed

Kara Ayers, ARNP, with MultiCare Women’s Health in Tacoma, often uses the Rotterdam criteria to make a diagnosis of PCOS in adults. This method of diagnosis requires the presence of at least two of the three following symptoms: irregular or absent periods, excess androgen levels (hyperandrogenism) or polycystic ovaries on ultrasound.

“In my practice, the symptom that brings people in the most is irregular periods,” Ayers says. “I also look for signs of excessive metabolic dysfunction/insulin resistance — excessive weight gain, difficulty losing weight.”

Ayers says she also looks for acne that’s persisted into adulthood and is difficult to treat, or abnormal hair growth on the jawline or in typical male patterns.

Although the name of the condition refers to cysts on the ovaries, their presence is not required for diagnosis.

When it comes to diagnosing PCOS in teens, the approach is slightly different. Rather than the Rotterdam criteria, the National Institutes of Health (NIH) criteria is used for adolescents. They overlap, but NIH criteria only uses menstrual irregularity and hyperandrogenism and excludes polycystic ovaries on ultrasound.

“We don’t use ultrasound as a diagnostic tool for teens, as adolescent ovaries tend to look polycystic anyway,” says Carri Holton, ARNP, with Mary Bridge Children’s Pediatric & Adolescent Gynecology. “For an adolescent with PCOS, it can present as irregular periods, absent periods or never starting their period at all.”

In addition to period patterns, lab work showing elevated testosterone and visible signs, like persistent acne or excess body hair, are other symptoms that can point to a PCOS diagnosis.

Treating PCOS

Because PCOS presents so differently person to person, treatment is not one-size-fits-all. The goal is to manage symptoms and protect long-term health.

“You can get 100 patients with PCOS, and they are all a little different, so their treatment is tailored to their symptoms,” Ayers says.

A common treatment for both adults and teens is birth control, which can help regulate periods, protect the lining of the uterus, reduce acne and control excessive hair growth by lowering testosterone levels.

And for those trying to conceive, metformin — a medication used to regulate insulin — can help improve menstrual cycles, which can in turn improve ovulation and fertility.

Spironolactone, an androgen blocker, is sometimes used to address symptoms like acne and hair growth.

“Because a teen’s primary concern isn’t about their fertility, our treatment focus is on lifestyle and symptom management, such as menstrual regulation, acne treatments and nutrition counseling,” Holton says. “We want to set them up for long-term health.”

Weight management for PCOS

An effective treatment for both teens and adults is weight management. Even a modest amount of weight loss — about 5 percent of body weight — can regulate cycles, protect fertility and reduce the effects of androgens.

“And it’s not just for symptom relief, but to protect from long-term complications from the condition,” Ayers says.

Weight loss can lower the risk of developing conditions like Type 2 diabetes, heart disease and sleep apnea.

“The development of GLP-1 medications has been an exciting step for PCOS patients to get the assistance they need to lose the weight that is so easily gained and so hard to lose,” she adds.

Fertility and PCOS

Fertility is one of the most common concerns adults may have after a PCOS diagnosis. The good news is that birth rates for those with PCOS are similar to those without it. The challenge is often timing: It may take longer to conceive than the average person because of irregular ovulation and may require more fertility assistance.

When the time comes to try for a baby, there are effective options. Medications like letrozole can help trigger ovulation.

“My whole goal is to just try to keep my patients as healthy as I can until they’re ready to get pregnant,” Ayers adds.

‘Natural’ alternatives to medication

“There is so much misunderstanding with PCOS,” Holton says. “There’s a lot on social media about it, and people don’t understand what it is.”

With PCOS being so widely discussed online, it’s common for patients to ask about natural alternatives to medication. Ayers says patients will ask about taking supplements versus hormones or if special diets work.

“Natural doesn’t always mean safe — we don’t have good studies on (natural remedies) or know how they affect high androgen or insulin levels,” she says. “PCOS is a hormonal disorder, so we often use hormones to treat it.”

That’s why hormone medications and lifestyle modifications like weight management are common and effective treatments.

“If you want to be 100 percent natural, it’s going to be lifestyle modification,” Ayers adds. “There’s no specific, proven diet for PCOS. It’s just going to be calorie restriction and portion control.”

Managing PCOS in the long term

Whether in adolescence or adulthood, managing PCOS requires a long-term commitment to health. The most important part of managing PCOS is finding the right treatment plan that works for them.

“As a gynecologic surgeon, if I suspect a patient has PCOS, I try to reiterate that this is a condition that is managed medically and does not require surgery,” adds Molly Dorroh, DO, with MultiCare Women’s Health in Tacoma. “PCOS often requires a collaborative team of providers to effectively manage the wide variety of symptoms.”