Approach to the diagnosis and treatment of polycystic ovarian syndrome in adolescent patients

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age. Its diagnosis during adolescence is particularly challenging, as physiological pubertal changes overlap with key features of PCOS; nevertheless, this developmental stage often represents the earliest window for clinical manifestation. Accordingly, a definitive diagnosis should be established only in the presence of clear and persistent evidence of both hyperandrogenism and menstrual irregularity. Adolescents presenting with a single feature should be considered at increased risk for PCOS and followed longitudinally, in order to minimize both underdiagnosis and overdiagnosis. Careful exclusion of alternative diagnoses is essential, as several conditions may mimic PCOS. Importantly, PCOS extends beyond reproductive dysfunction and constitutes a chronic condition associated with long-term metabolic risk and adverse mental health outcomes. This broader disease spectrum underscores adolescence as a critical period for early risk stratification and preventive interventions. Management should prioritize lifestyle modification as the foundation of therapy, with pharmacological treatment individualized according to clinical presentation, metabolic profile, contraindications, and patient preferences. Combined oral contraceptive pills remain the first-line therapy for menstrual irregularity and hyperandrogenism and provide an important opportunity for counseling on sexual and reproductive health, including pregnancy prevention and protection against sexually transmitted infections. Metformin is recommended as first-line therapy for metabolic comorbidities, mirroring its established role in adult populations. All these considerations highlight adolescence as an important stage for accurate diagnosis, comprehensive risk assessment, and timely intervention in PCOS, with potential implications for long-term reproductive, metabolic, and psychosocial health.