Polycystic Ovary Syndrome – Support and Prevention in Adolescence

Abstract

For up to eight years after menarche, adolescents are in a developmental stage where PCOS (polycystic ovary syndrome) symptoms are physiological. The diagnostic criteria for PCOS in adult women therefore only partially apply. A new German S2k guideline and the international PCOS guideline of 2023 provide standardized diagnostic criteria for hyperandrogenemia and menstrual disorders in adolescence. The provisional diagnosis of PCOS at risk has been introduced for adolescents who only partially meet the criteria and this diagnosis must be revisited three and eight years after menarche. Recommendations for therapy focus on providing information and lifestyle advice to adolescents and on the prevention and treatment of possible comorbidities such as obesity, insulin resistance and hypertension. This paper presents an overview of a structured diagnostic workup and therapeutic approaches to support adolescents with PCOS.

 

MissingLinkText

Keywords

polycystic ovary syndrome - adolescence - diagnostic criteria - prevention - guideline

Introduction

Stein and Leventhal already reported on the association between polycystic ovaries and irregular menstrual cycles in 1935 [1]. In subsequent decades, the symptom complex of irregular cycles and abnormal ovarian morphology (polycystic ovarian morphology, PCOM) was amended by the addition of clinical and biochemical hyperandrogenism confirmed by laboratory tests and was called polycystic ovary syndrome (PCOS) [2]. Women with PCOS have a higher risk of developing metabolic, psychological, and cardiovascular comorbidities and present more commonly with impaired fertility [3] [4].

The pathogenesis of PCOS has been only partially elucidated. Previous findings and insights have been combined in a multifactorial model: genetic predisposition and lifestyle influences (from fetal programming in the womb to diet and exercise in childhood and adulthood) play a role. A disorder of the gonadotropin-ovary axis with tonic LH secretion from the hypophysis, follicular arrest, and hyperandrogenism has been reported [5]. It is still not clear whether PCOS has a neuroendocrine or an ovarian origin.

Irrespective of the body mass index (BMI) of affected women, the metabolic aspect of the PCOS phenotype includes increased insulin resistance [6]. Changes in the endocrine function of adipose tissue contribute to this through decreased adiponectin levels and increased androgen secretion [7].

Depending on the classification, 8–13% of all adult women are affected by PCOS. But PCOS symptoms have already been observed in 4–11% of adolescents [8] [9]. There is an ethnic component to PCOS, with a low prevalence in Central Europe (4.3%) compared to the Mediterranean region (6.1%) and to Southeast Asia (11.4%) [8]. Adolescents represent a special group of patients who should be differentiated from adult women with PCOS because they have not yet completed puberty [10].

In recent years, international and national consensus groups have attempted to align diagnostic workup and treatment recommendations for women with PCOS. In 2018, an international guideline group which included affected women formulated the first evidence-based diagnostic and therapeutic recommendations based on an extensive search of the literature. The recommendations were updated in 2023 [11]. A German S2k guideline, developed in consultation with gynecological, internal medicine and pediatric medical societies, will be published shortly [12]. The new guidelines have focused more on the specific features of a PCOS diagnosis in adolescence and discuss these special features as well as the much lower evidence for diagnostics and therapy in adolescence.

This overview provides an update on the clinical care of adolescents with suspected PCOS from the perspective of pediatric endocrinology. In the current guidelines therapy for adolescence is focused on prevention.

 

MissingLinkText

Review

Diagnostics

All the symptoms of the classic PCOS triad can occur during female puberty even without a significant pathology. Polycystic ovaries on imaging are a normal finding in adolescence [13] [14] [15] [16]. Differentiating PCOS symptoms from normal variants is challenging and can only be achieved over the further clinical course. Older PCOS classifications and scientific evaluations prior to 2018 did not always take the specific features of the first years after menarche into account, which has contributed to the heterogeneous data.

In the current international guideline, adolescence is used to refer to the eight years after menarche. A diagnosis of PCOS in this period is based on a combination of menstrual cycle disorders and hyperandrogenism (see [Table 1]). If only one of these criteria is met, the diagnosis of PCOS at risk is made, which should be re-evaluated again three and eight years after menarche to review whether the diagnostic criteria for adolescents or adult women have now been met.

Table 1 Diagnostic criteria for a diagnosis of PCOS in adolescents according to the current guidelines. Data from: [8] [11] [17]. PCOS is diagnosed if both criterion 1 and criterion 2 are met. If only criterion 1 or only criterion 2 is met, a diagnosis of PCOS at risk is made and re-evaluated three and eight years after menarche.

1. Irregular periods/oligomenorrhea
Time after menarche	Definition of “irregular menstrual cycle”
≤ 1 year	Physiological
1–3 years	Cycle length < 21 days or > 45 days
> 3 years	Cycle length < 21 or > 35 days or < 8 cycles per year
> 1 year	Secondary amenorrhea > 90 days
Primary amenorrhea	From 15th birthday or > 3 years after onset of secondary breast development
2. Hyperandrogenism: a) Laboratory tests b) Clinical: medium to severe hirsutism, severe acne
3. Exclusion of possible differential diagnoses

As even in adolescence PCOS is a diagnosis of exclusion, diagnostic tests and examinations are used to first investigate possible differential diagnoses and secondly to identify comorbidities. Sonography of the uterus and ovaries is useful to exclude structural anomalies or endometrial hyperplasia in patients with irregular menstrual cycles. A finding of PCOM on ultrasound is not part of the diagnostic testing for PCOS in adolescents. [Table 2] provides an overview of a structured evaluation of a patient’s medical history as well as the clinical examinations and diagnostic tests used to classify symptoms and arrive at a diagnosis.

Table 2 Structured taking of the patient’s medical history, examinations, and diagnostic tests to identify PCOS in adolescents based on current guidelines. Data from: [8] [11] [17].

Medical history
Complaints: heat/cold intolerance; tachycardia/bradycardia (hypo-/hyperthyroidism) stretch marks, tiredness, muscle weakness (Cushing’s syndrome) Body hair: pubarche, start of additional development of body hair which takes the form of hirsutism, dynamics (rapid onset, differential diagnosis: tumor), local hair removal: which methods are used, at what intervals Course of puberty (thelarche, menarche), medical history of menstrual cycles Medications Familial medical history: menstrual disorders/assisted reproduction in female members of the family? Diabetes mellitus in the family Smoking Daily activities/sports
Considerations for clinical examinations	Comment
Blood pressure, heart rate, height (percentile), weight (percentile), BMI (percentile)	Overweight, obesity, and extreme obesity are defined as a BMI above the age and sex-specific 90th/97th and 99.5th percentile, respectively [18]. The BMI calculator of the AGA can be used to calculate BMI [19].
Hirsutism	Pigmented terminal hairs (untreated length > 5 mm) with male pattern distribution, modified Ferriman-Gallway score, no cut-off value in adolescence
Acne	Moderately severe acne is defined as more than 10 facial lesions (blackheads in early puberty and inflammatory lesions – papules and pustules – in the perimenarchal years). Severe acne is defined as the presence of more than two nodes of more than 1 cm or abscesses
Alopecia (female pattern hair loss)	Ludwig/Olsen visual scale
Acanthosis nigricans
Other abnormalities	Signs of galactorrhea, acromegaly, gigantism, growth rate
Recommended diagnostic workup	Justification
Total testosterone, free androgen index (FAI, total testosterone/SHBG) and poss. androstenedione and dehydroepiandrosterone sulfate (DHEAS)	Hyperandrogenism; caution: standard values depend on age/pubertal status
Prolactin	Investigate for (to exclude) prolactinoma
TSH, fT4	Investigate for hyperthyroidism/hypothyroidism
17-Hydroxyprogesterone, poss. ACTH test	Investigate for non-classic congenital adrenal hyperplasia (NCCAH, formerly late onset AGS)
FSH, LH	Primary ovarian insufficiency/hypothalamic amenorrhea
Cortisol, poss. ACTH, dexamethasone short test (1 mg)	If there is a clinical suspicion of Cushing’s syndrome
Investigate for androgen-expressing tumors	In cases with pronounced hirsutism
Sonography of the abdomen with imaging of the uterus and ovaries as well as the adrenal glands	Investigate structural anomalies in cases with primary amenorrhea and androgen-producing tumors of the adrenal glands or ovaries
Medical history, poss. β-HCG	Pregnancy
Fasting blood sugar, HbA1 c, HDL, LDL, total cholesterol, triglycerides	Associated metabolic complications

Although the new international guidelines state that elevated anti-Müllerian hormone (AMH) levels may be used as a diagnostic criterion for PCOS in adult women, they should not be used to diagnose PCOS in adolescents because there are no cut-off values for adolescents.

Screening for metabolic and psychological comorbidities is part of the expanded diagnostic testing for PCOS and as the basis for therapeutic support in adolescence, as the risk of overweight, obesity, glucose and lipid metabolism disorders as well as fatty liver disease (metabolic dysfunction-associated steatotic liver disease (MASLD, formerly non-alcoholic steatotic hepatitis, NASH) and hypertension is significantly higher [20] [21].

 

MissingLinkText

Multimodal support and prevention

Patient-centered information

After a diagnosis of PCOS or PCOS at risk has been made, the adolescent and their caregivers should be informed about the syndrome and its symptoms. An evolutionary perspective may be useful to create an environment conducive to promoting a healthy lifestyle and prevention. It has been suggested that PCOS may be a genetic variant optimally adapted to times of famine. In times when food was scarce, insulin resistance, hyperandrogenism and fat storage may have led to faster ovulation and pregnancy and therefore resulted in a fertility benefit [22]. However, under the sedentary conditions of our modern society with easy access to nutritionally dense foodstuffs, persons with a PCOS phenotype affected by overweight and obesity face disadvantages such as hirsutism, diabetes, and decreased fertility. The increased prevalence of PCOS, which has risen as obesity rates have increased, is consistent with this hypothesis [23]. Lifestyle changes are therefore essential to prevent the risk associated with PCOS.

Ideally, when families are informed about PCOS, they should be provided with materials providing detailed information. The German self-help group PCOS Selbsthilfe Deutschland e. V. has developed materials available online which were last updated in 2014 [24]. The international guideline group have compiled relatable, current, digital materials in English [25]. Unfortunately, information specifically aimed at adolescents and young women is not available.

 

MissingLinkText

Obesity and metabolism

Advice about maintaining a healthy lifestyle in adolescence is an important part of prevention. This is where an early diagnosis of PCOS may contribute to taking preventive measures in good time and thereby preventing long-term comorbidities [26]. Adolescents should be informed about the higher metabolic risk of women with PCOS. Nutrition counseling (to achieve a low-energy balanced mixed diet) and advice on taking sufficient exercise every day (90 minutes per day) are essential to prevent normal-weight adolescents from becoming overweight [27] [28].

When adolescents are overweight (> 90th BMI percentile) or obese (> 97th BMI percentile, which corresponds to a BMI of 30 kg/m² in adult women) the aim must be to implement lifestyle changes. A structured lifestyle intervention with multidisciplinary support is required. A list of certified treatment facilities in Germany is available on the homepage of the German working group on obesity in childhood and adolescence (Arbeitsgemeinschaft Adipositas im Kinder- und Jugendalter, AGA) [29]. Successful lifestyle changes can lead to improvements in the clinical presentation and the laboratory test results [30].

Screening for metabolic comorbidities and risk factors is part of the initial diagnostic workup for PCOS and should be continued with medical support.

For adolescents with PCOS this includes monitoring blood pressure, weight, carbohydrate and lipid metabolism, and screening for MASLD [31]. The intervals between examinations depend on the clinical presentation. It is important to remember that certain levels of insulin resistance in puberty are physiological and may improve over time. Age-adapted standard values should therefore be used to evaluate surrogate markers of insulin resistance [32].

Patients with extreme obesity (> 99th BMI percentile) should additionally be screened for obstructive sleep apnea syndrome (OSAS). A standardized questionnaire is available for screening (pediatric sleep questionnaire: Sleep-Disordered Breathing Subscale Version 1.0 GERMAN, PSQ-SRBD-Subscale-DE: Wiater/Sagheri 2009). A sleep study should be done if abnormalities are detected.

Existing hyperlipidemia, glucose metabolism disorders, or hypertension must be treated in accordance with the recommendations in current guidelines [33].

 

MissingLinkText

Mental health and quality of life

Higher rates of depression, anxiety and eating disorders (such as binge eating or bulimia) have been reported for adolescents and women with PCOS [34]. This may make it more difficult to implement lifestyle changes.

For this reason, the current guidelines recommend screening for or increased attention being paid to psychological comorbidities with the initiation of suitable therapy if there is evidence of anomalies. The German guideline does not offer any concrete proposals on suitable screening tools. Short questionnaires such as the SCOFF for eating disorders and the PHQ9 for depressive symptoms can be useful in daily clinical practice [35] [36].

Complaints such as hirsutism, worries about fertility, and being overweight/obesity may reduce adolescents’ health-related quality of life. More and more disease-specific questionnaires are being developed [37]. For overweight adolescents, lifestyle changes which lead to weight loss may result in a better quality of life [38]. This underscores the importance of prevention when supporting adolescents with PCOS.

 

MissingLinkText

Symptoms of hyperandrogenism (hirsutism, acne)

Treatment for the dermatological effects of hyperandrogenism focuses on the symptoms. There is no causative therapy.

Local measures to reduce hirsutism mainly consist of laser and photo epilation or chemical depilation with eflornithine. The cost of laser treatment is not usually covered by statutory health insurance in Germany. When hirsutism leads to depression or social withdrawal, a psychological and medical statement may be used in individual cases to apply to the patient’s health insurance company to cover the costs. IPL (intense pulsed light) procedures are less effective compared to diode lasers, although no data is available on IPL home use devices [39]. Treatment is customized to the individual. Other potential cosmetic procedures include shaving, bleaching, or waxing.

Dermatologically prescribed topical treatment is used to treat common acne [40].

Combined oral contraceptives (COC) are a drug-based option to treat hyperandrogenism. COC improve the clinical symptoms of acne in just a few months and decrease hirsutism when combined with laser and photo epilation [39] [41]. However, an impact on hirsutism can only be expected after at least 6 months of treatment and varies according to the extent of symptoms.

COC is an off-label indication for patients with PCOS. COC increase sexual hormone-binding globulin (SHBG) levels and decrease LDL, testosterone, and androstenedione levels. There is currently no evidence that antiandrogenic progestins are more clinically effective [42]. Moreover, use of chlormadinone acetate and cyproterone acetate is restricted because of the increased associated risk of meningioma [43] [44]. According to current scientific knowledge, a combined oral contraceptive with a low thrombogenic risk (estradiol < 30 µg and the progestins levonorgestrel, norethisterone) should be used to treat hyperandrogenism in adolescents with PCOS [42]. The decision for therapy should be an individual choice based on shared decision making involving the adolescent and her parents. The response to treatment is difficult to quantify objectively and may be reviewed using photographic documentation. The emphasis of treatment is on improving the psychological distress of the affected adolescent.

 

MissingLinkText

Treatment of cycle disorders

PCOS-related cycle disorders in adolescence do not require primary treatment as long as the patient is not under psychological stress and has no bleeding disorders such as juvenile dysfunctional bleeding or hypermenorrhea.

Regulation of the menstrual cycle can lead to weight loss in overweight adolescents [30]. Metformin may also be used, although prescribing metformin for PCOS is an off-label indication. Insulin sensitizers and GLP-1 agonists are also effective, probably through the indirect effect of improving insulin resistance through weight loss [45] [46] [47]. GLP-1 agonists (liraglutide, dulaglutide) are significantly more expensive and in Germany, they are only approved to treat type 2 diabetes for adolescents above the age of 10. Menstrual cycle regulation can also be achieved by treating adolescents with hormonal contraceptives (see symptoms of hyperandrogenism). The treatment is off-label and patients must be informed accordingly. There is no evidence that one of the treatment options (COC versus metformin) is better than the other [43].

PCOS and a BMI of > 30 kg/m² are risk factors for endometrial hyperplasia because of the permanent imbalance created by the effect of endogenous estrogen on the endometrium [48] [49]. The current guidelines do not recommend specific screening examinations or preventive therapies, as the overall incidence of endometrial cancer is low and screening does not decrease endometrial cancer-specific mortality [50].

Adolescents with PCOS usually do not have estrogen deficiency, which is defined as an estradiol level under persistent amenorrhea of < 200 pmol/l [51]. The studies to date on bone density and fracture rates are inconsistent. According to a recently published meta-analysis, the fracture risk was not significantly higher [52]. Hormone replacement therapy with 17-β estradiol and progestin may be considered in individual cases with long-term amenorrhea and persistently low estradiol levels.

 

MissingLinkText

Contraception, fertility, and offspring

Adolescents with PCOS should be advised that they have a good chance of developing normal fertility at a later stage, even if supportive medical measures may be required in adolescence [53]. Adolescents with amenorrhea should therefore take contraceptives. Normal weight is an important parameter with a positive impact on fertility [17]. There is no drug therapy that can preventively improve fertility.

Women with PCOS have a higher risk of pregnancy-related complications [18]. Here too, prevention and a healthy lifestyle are essential to improve the outcome of mother and child. Female offspring have a higher risk of also developing PCOS [19]. Excessive maternal weight gain, a sedentary lifestyle of the mother in pregnancy, and early signs of being overweight in early childhood are negative prognostic factors [23]. Young women can be already be informed about these risk factors in adolescence and the provision of such information should be continued in the context of their care until they have fulfilled their wish to have children.

 

MissingLinkText

Transition

Both the PCOS and PCOS at risk diagnosis should be reviewed in all adolescents three years after menarche. Adolescents should then be examined eight years after menarche to see whether they now meet the PCOS criteria for adult women. At this point, sonography of the ovaries to check for PCOM and determination of AMH can be used as diagnostic criteria.

It has become clear that to obtain guidelines-based therapy, adolescents must transition to adult medicine (Gynecological Endocrinology /Gynecology/Internal Medicine & Endocrinology) if they previously received treatment from pediatric endocrinology departments [31]. There are currently no established care paths for transition. A structured transition could follow the approach used in pilot projects such as the Berlin Transition Program [54]. A guideline for the transition of obese adolescents is currently being compiled.

 

MissingLinkText

 

MissingLinkText

 

MissingLinkText

Conclusions

The latest guidelines have summarized and standardized current knowledge about the diagnostic workup for PCOS.

Care offered to adolescents focuses on the prevention and treatment of metabolic and psychological comorbidities. Prevention of PCOS-related metabolic complications and subsequent reduction of fertility are a key pillar of PCOS therapy in adolescence. Multiprofessional multimodal support to implement lifestyle changes can be useful. Drug therapy (off-label) to treat menstrual cycle disorders and hyperandrogenism may be offered to adolescents suffering psychological stress. In practice, the introduction of the PCOS at risk diagnosis for adolescents is helpful as it demonstrates an appropriate understanding of the dynamic changes occurring in puberty. This time-limited diagnosis should provide a low threshold access to the preventive measures described above. At the same time, a reevaluation of the diagnosis at three and eight years after menarche should prevent long-term labelling of women who develop transient symptoms during puberty. It remains to be seen in the coming years to what extent a diagnosis of PCOS at risk will be useful in daily clinical practice without it leading to overtreatment of adolescents.

Although the current guideline has updated existing diagnostic approaches and care in line with international recommendations, some questions remain unanswered and will require further scientific investigation. For example, there are currently no uniform standard values for androgen levels in adolescents, and the role of androgens other than testosterone is currently not reflected in the clinical diagnostic workup [55]. The data on optimal therapeutic strategies is patchy, despite a significant increase in publications and open questions must be resolved to improve care and counseling.

Further standardization and the creation of care paths for a coordinated transition to adult care are needed to ensure that affected adolescents receive guidelines-based care.

 

MissingLinkText

 

MissingLinkText

Conflict of Interest

The authors declare that they have no conflict of interest.

• References/Literatur

• 1 Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935; 29: 181-191
• 2 Azziz R, Adashi EY. Stein and Leventhal: 80 years on. Am J Obstet Gynecol 2016; 214: 247.e1-247.e11
• 3 Berni TR, Morgan CL, Rees DA. Women With Polycystic Ovary Syndrome Have an Increased Risk of Major Cardiovascular Events: a Population Study. J Clin Endocrinol Metab 2021; 106: e3369-e3380
• 4 West S, Vahasarja M, Bloigu A. et al. The impact of self-reported oligo-amenorrhea and hirsutism on fertility and lifetime reproductive success: results from the Northern Finland Birth Cohort 1966. Hum Reprod 2014; 29: 628-633
• 5 Joham AE, Norman RJ, Stener-Victorin E. et al. Polycystic ovary syndrome. Lancet Diabetes Endocrinol 2022; 10: 668-680
• 6 Stener-Victorin E, Teede H, Norman RJ. et al. Polycystic ovary syndrome. Nat Rev Dis Primers 2024; 10: 27
• 7 Hagberg CE, Spalding KL. White adipocyte dysfunction and obesity-associated pathologies in humans. Nat Rev Mol Cell Biol 2024; 25: 270-289
• 8 Neven ACH, Forslund M, Ranashinha S. et al. Prevalence and accurate diagnosis of polycystic ovary syndrome in adolescents across world regions: a systematic review and meta-analysis. Eur J Endocrinol 2024; 191: S15-S27
• 9 Pena AS, Codner E, Witchel S. Criteria for Diagnosis of Polycystic Ovary Syndrome during Adolescence: Literature Review. Diagnostics (Basel) 2022; 12: 1931
• 10 Pena AS, Witchel SF, Hoeger KM. et al. Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC Med 2020; 18: 72
• 11 Teede HJ, Tay CT, Laven JJE. et al. International PCOS Network. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol 2023; 189: G43-G64
• 12 AWMF. Anmeldung S2k-Leitlinie Diagnostik und Therapie des polyzystischen Ovarsyndroms (PCOS). 2025 Zugriff am 11. Februar 2025 unter: https://register.awmf.org/de/leitlinien/detail/089-004
• 13 Codner E, Villarroel C, Eyzaguirre FC. et al. Polycystic ovarian morphology in postmenarchal adolescents. Fertil Steril 2011; 95: 702-706.e1–2
• 14 Kelsey TW, Dodwell SK, Wilkinson AG. et al. Ovarian volume throughout life: a validated normative model. PLoS One 2013; 8: e71465
• 15 Assens M, Dyre L, Henriksen LS. et al. Menstrual Pattern, Reproductive Hormones, and Transabdominal 3D Ultrasound in 317 Adolescent Girls. J Clin Endocrinol Metab 2020; 105: dgaa355
• 16 Fulghesu AM, Canu E, Casula L. et al. Polycystic Ovarian Morphology in Normocyclic Non-hyperandrogenic Adolescents. J Pediatr Adolesc Gynecol 2021; 34: 610-616
• 17 Legro RS, Dodson WC, Kris-Etherton PM. et al. Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2015; 100: 4048-4058
• 18 Mills G, Badeghiesh A, Suarthana E. et al. Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies. Hum Reprod 2020; 35: 1666-1674
• 19 Vink JM, Sadrzadeh S, Lambalk CB. et al. Heritability of polycystic ovary syndrome in a Dutch twin-family study. J Clin Endocrinol Metab 2006; 91: 2100-2104
• 20 Hudnut-Beumler J, Kaar JL, Taylor A. et al. Development of type 2 diabetes in adolescent girls with polycystic ovary syndrome and obesity. Pediatr Diabetes 2021; 22: 699-706
• 21 Manzano-Nunez R, Santana-Dominguez M, Rivera-Esteban J. et al. Non-Alcoholic Fatty Liver Disease in Patients with Polycystic Ovary Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression. J Clin Med 2023; 12: 856
• 22 Parker J, O’Brien C, Hawrelak J. et al. Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment. Int J Environ Res Public Health 2022; 19: 1336
• 23 Koivuaho E, Laru J, Ojaniemi M. et al. Age at adiposity rebound in childhood is associated with PCOS diagnosis and obesity in adulthood-longitudinal analysis of BMI data from birth to age 46 in cases of PCOS. Int J Obes (Lond) 2019; 43: 1370-1379
• 24 PCOS Selbsthilfe Deutschland e. V.. Herzlich willkommen bei der PCOS Selbsthilfe Deutschland. 2024 Zugriff am 01. November 2024 unter: https://www.pcos-selbsthilfe.org/
• 25 MCHRI. Resources for Women with PCOS. 2024 Zugriff am 01. November 2024 unter: https://mchri.org.au/guidelines-resources/community/pcos-resources/
• 26 Riestenberg C, Jagasia A, Markovic D. et al. Health Care-Related Economic Burden of Polycystic Ovary Syndrome in the United States: Pregnancy-Related and Long-Term Health Consequences. J Clin Endocrinol Metab 2022; 107: 575-585
• 27 Bundesinstitut für Öffentliche Gesundheit. Förderung eines gesunden Lebensstils im Kindes- und Jugendalter. 2024 Zugriff am 22. Januar 2025 unter: https://www.bzga.de/was-wir-tun/ernaehrung-bewegung-entspannung/
• 28 Deutsche Gesellschaft für Ernährung. Ernährungsempfehlungen für Deutschland. 2024 Zugriff am 22. Januar 2025 unter: https://www.dge.de/gesunde-ernaehrung/gut-essen-und-trinken/
• 29 Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA). Behandlungseinrichtungen (nach AGA zertifiziert). 2024 Zugriff am 05. November 2024 unter: https://adipositas-gesellschaft.de/aga/behandlungseinrichtungen/
• 30 Marzouk TM, Sayed Ahmed WA. Effect of Dietary Weight Loss on Menstrual Regularity in Obese Young Adult Women with Polycystic Ovary Syndrome. J Pediatr Adolesc Gynecol 2015; 28: 457-461
• 31 Simon SL, Phimphasone-Brady P, McKenney KM. et al. Comprehensive transition of care for polycystic ovary syndrome from adolescence to adulthood. Lancet Child Adolesc Health 2024; 8: 443-455
• 32 Hammel MC, Stein R, Kratzsch J. et al. Fasting indices of glucose-insulin-metabolism across life span and prediction of glycemic deterioration in children with obesity from new diagnostic cut-offs. Lancet Reg Health Eur 2023; 30: 100652
• 33 AWMF. S3-Leitlinie Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter Version 4.0. 2023 Zugriff am 31. Juli 2025 unter: https://register.awmf.org/de/leitlinien/detail/057-016
• 34 Lee I, Cooney LG, Saini S. et al. Increased odds of disordered eating in polycystic ovary syndrome: a systematic review and meta-analysis. Eat Weight Disord 2019; 24: 787-797
• 35 Gräfe K, Zipfel S, Herzog W. et al. Screening psychischer Störungen mit dem „Gesundheitsfragebogen für Patienten (PHQ-D)“. Diagnostica 2004; 50: 171-181
• 36 Lopez-Gil JF, Garcia-Hermoso A, Smith L. et al. Global Proportion of Disordered Eating in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatr 2023; 177: 363-372
• 37 Saei Ghare Naz M, Ozgoli G, Ahmadi F. et al. Adolescents’ polycystic ovary syndrome health-related quality of life questionnaire (APQ-20): development and psychometric properties. Eur J Pediatr 2023; 182: 2393-2407
• 38 Dokras A, Sarwer DB, Allison KC. et al. Weight Loss and Lowering Androgens Predict Improvements in Health-Related Quality of Life in Women With PCOS. J Clin Endocrinol Metab 2016; 101: 2966-2974
• 39 Monash University, European Society of Endocrinology, American Society für Reproductive Medicine, Centre for Research Excellence in Women’s Health in Reproductive Life, Centre for Research Excellence in Polycystic Ovary Syndrome, eshre, Endocrine Society. Technical Report for the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023 Update. Zugriff am 31. Juli 2025 unter: https://www.monash.edu/__data/assets/pdf_file/0010/3379591/TechnicalReport-2023.pdf
• 40 Reynolds RV, Yeung H, Cheng CE. et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2024; 90: 1006.e1-1006.e30
• 41 Arowojolu AO, Gallo MF, Lopez LM. et al. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev 2012; (07) CD004425
• 42 Forslund M, Melin J, Alesi S. et al. Different kinds of oral contraceptive pills in polycystic ovary syndrome: a systematic review and meta-analysis. Eur J Endocrinol 2023; 189: S1-S16
• 43 Bundesinstitut für Arzneimittel und Medizinprodukte (bfarm). Anwendungsbeschränkungen von Cyproteronacetat aufgrund des Risikos für Meningeome. 2022 Zugriff am 13. Mai 2025 unter: https://www.bfarm.de/SharedDocs/Risikoinformationen/Pharmakovigilanz/DE/RHB/2020/rhb-cyproteron.html
• 44 Bundesinstitut für Arzneimittel und Medizinprodukte (bfarm). Chlormadinonacetat und Nomegestrolacetat: Maßnahmen zur Minimierung des Meningeomrisikos. Rote Hand Brief 2022. 2025 Zugriff am 13. Mai 2025 unter: https://www.bfarm.de/SharedDocs/Risikoinformationen/Pharmakovigilanz/DE/RHB/2022/rhb-chlormadinon-nomegestrol.html
• 45 Al Khalifah RA, Florez ID, Dennis B. et al. Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis. Pediatrics 2016; 137: e20154089
• 46 Elkind-Hirsch KE, Chappell N, Shaler D. et al. Liraglutide 3 mg on weight, body composition, and hormonal and metabolic parameters in women with obesity and polycystic ovary syndrome: a randomized placebo-controlled-phase 3 study. Fertil Steril 2022; 118: 371-381
• 47 Reiser E, Lanbach J, Bottcher B. et al. Non-Hormonal Treatment Options for Regulation of Menstrual Cycle in Adolescents with PCOS. J Clin Med 2022; 12: 67
• 48 Johnson JE, Daley D, Tarta C. et al. Risk of endometrial cancer in patients with polycystic ovarian syndrome: A meta-analysis. Oncol Lett 2023; 25: 168
• 49 Rosen MW, Tasset J, Kobernik EK. et al. Risk Factors for Endometrial Cancer or Hyperplasia in Adolescents and Women 25 Years Old or Younger. J Pediatr Adolesc Gynecol 2019; 32: 546-549
• 50 AWMF. S3-Leitlinie Endometriumkarzinom. 2024 Zugriff am 13. Mai 2025 unter: https://register.awmf.org/de/leitlinien/detail/032-034OL
• 51 Jayasena CN, Devine K, Barber K. et al. Society for endocrinology guideline for understanding, diagnosing and treating female hypogonadism. Clin Endocrinol (Oxf) 2024; 101: 409-442
• 52 Prior JC, Shirin S, Goshtasebi A. Bone health and prevalent fractures in women with polycystic ovary syndrome: a meta-analysis and endocrine-context pathophysiology review. Expert Rev Endocrinol Metab 2023; 18: 283-293
• 53 Hancke K. PCOS – Kinderwunsch und Schwangerschaft. Geburtshilfe Frauenheilkd 2024; 84: 602-606
• 54 Berliner Transitionsprogramm. Informationen für Fach- und Hausärzte. 2024 Zugriff am 05. November 2024 unter: https://www.btp-ev.de/berliner-transitionsprogramm/informationen-fur-fach-und-hausarzte/
• 55 Adriaansen BPH, Oude Alink SE, Swinkels DW. et al. Reference intervals for serum 11-oxygenated androgens in children. Eur J Endocrinol 2024;

Publikationsverlauf

Eingereicht: 12. März 2025

Angenommen nach Revision: 26. Mai 2025

Artikel online veröffentlicht:
01. August 2025