A Guide for School Nurses, Health Educators, and Others

Understanding Polycystic Ovary Syndrome (PCOS) in Teens:
A Guide for School Nurses, Health Educators, and Others

Polycystic Ovary Syndrome (PCOS) is the most common reproductive endocrine disease among women of childbearing age. Although this condition has not received much publicity, it impacts many young women. In fact 5-10% of teens and young women have this diagnosis. The most common symptoms are irregular periods, weight gain, acne, and excess facial and body hair. The severity of the symptoms varies from girl to girl. Most young women are generally distressed with how the symptoms impact their life and self esteem. Having an understanding of this disease, the etiology, current trends in medical treatment, and the important role of good nutrition and exercise will help you to support teen girls with PCOS.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a hormone imbalance that can cause irregular periods, unwanted hair growth, and acne. The name “Poly”, meaning “many”, and “Cystic”, meaning “cysts”, refers to the fact that those with PCOS may have enlarged ovaries that contain many very small cysts. These small cysts also called follicles develop in the ovary but the eggs are only rarely released. The outer wall of the ovaries thickens giving the ovary a polycystic appearance. These cysts are not cancerous and do not need to be surgically removed. It is not uncommon for girls with PCOS to have normal appearing ovaries but still have an imbalance in their hormone levels. Generally, symptoms of PCOS begin during the teenage years around the start of menstruation and can be mild or severe. The extent of symptoms and their severity varies significantly among young women. What most health care providers will agree on is that young women with this disorder have irregular menstrual cycles and they have higher than normal levels of androgens (male hormones) in their blood.

What are the signs of PCOS?

Young women with PCOS commonly have one or more signs. Some of the most common signs include:

Irregular periods—periods that come every few months, not at all, or too frequently
Hirsutism—extra hair on the face or other body parts
Acne
Weight gain and/or trouble losing weight, and in some cases, obesity
Patches of dark skin on the back of the neck and other areas, called “acanthosis nigricans”
Infertility or impaired fertility due to irregular periods or lack of ovulation
Other less common signs/symptoms may include:

Hair thinning (on the top of the head)
Skin tags under the armpits or neck area
High total cholesterol and/or low HDL “good cholesterol”
High blood pressure
Pre-diabetes or in some cases, diabetes
Can you tell if a young woman has PCOS?

If a teen or young woman you know has 2 or more of the above symptoms, she could have PCOS. There can be other reasons for these symptoms and therefore only a health care provider can tell for sure. If the young woman is distressed about the symptoms she is experiencing, you should suggest that she see her primary care provider. While she is waiting for her appointment, you can advise her to keep a log of her menstrual cycles and symptoms. She should bring the log with her when she meets with her provider. After an initial evaluation is completed, she may be referred to an adolescent gynecologist, or an endocrinologist for further testing.

What causes PCOS?

PCOS is caused by an imbalance in the hormones secreted by the pituitary gland that in turn affects the ovaries. Many girls with PCOS also have higher than normal levels of insulin from the pancreas. PCOS usually happens when the luteinizing hormone (LH) levels or the insulin levels are too high, which results in extra testosterone production by the ovary.