How to differentiate Adolescent physiological anovulation and Adolescent PCO??

 the challenge of differentiating normal ‘physiological adolescent anovulation’ from true ovulatory dysfunction, but highlighted that most adolescent menstrual cycles still fall within certain parameters.

 

 As such, the following were recommended as evidence of ovulatory dysfunction in adolescents: (I) consecutive menstrual intervals >90 days even in the first year after menarche; (II) menstrual intervals persistently <21 or >45 days 2 or more years after menarche; and (III) lack of menses by 15 or 2–3 years after breast budding.

Persistent elevation of serum total and/or free testosterone level determined in a reliable reference laboratory were put forth as the best evidence of biochemical androgen excess in an adolescent girl with symptoms of PCOS.

Although isolated mild hirsutism was considered normal in the early post-menarcheal years, moderate to severe hirsutism was endorsed as clinical evidence of androgen excess as was persistent acne unresponsive to topical therapy. It was recommended that the latter be evaluated for presence of hyperandrogenemia prior to initiation of medical therapies.

With regards to PCOM(poly Cystic Ovarian Morphology) in diagnosing Adolescent PCO   the consensus concluded that ovarian imaging can be deferred during the diagnostic evaluation of PCOS in adolescents until high-quality data for PCOM are available.

 As such, the diagnosis of PCOS in adolescent currently hinges on evidence of ovulatory dysfunction and androgen excess.

Additional important diagnostic considerations highlighted in the consensus publication included:

 I.          A definitive diagnosis of PCOS is not needed to initiate treatment. Early treatment may decrease risk of future comorbidity even in the absence of a definitive diagnosis;

II.          Deferring the diagnosis of PCOS, while offering symptom treatment and providing regular/frequent follow-up of symptomology, is a recommended option;

III.          Obesity, hyperinsulinemia, and insulin resistance are recognized as common in adolescents with PCOS, but these features should not be used for diagnostic purposes;

Other causes of hyperandrogenemia and irregular menstrual periods must be ruled out before a diagnosis of PCOS can be established