PCOS Awareness Month: Why are Teens at Risk of PCOS Overdiagnosis

September marks Polycystic Ovary Syndrome (PCOS) Awareness Month, a time dedicated to increasing understanding of one of the most common hormonal conditions that affect women.

As attention turns to early detection and treatment, researchers caution that PCOS is frequently overdiagnosed in teenagers nowadays because normal features of puberty are often mistaken for signs of the disorder.

A 2018 study in the British Journal of General Practice found that the reported prevalence of polycystic ovary syndrome (PCOS) changes significantly depending on which diagnostic criteria are used.

Researchers said this wide gap shows why applying adult definitions to teenagers with PCOS symptoms can increase the risk of overdiagnosis in adolescents.

Irregular menstrual cycles are a common sign of PCOS in teenagers, but they are also normal in the first few years after menarche.

A 2020 review in Obstetric Medicine reported that up to 95 percent of cycles become regular within three years. Acne and mild excess hair growth are also typical during puberty and do not always indicate adolescent PCOS. This overlap between normal puberty symptoms and PCOS can make early diagnosis challenging.

MedBound Times connected with Dr. Sudipta Banerjee Oberoi, MRCOG DNB, Consultant Obstetrician and Gynaecologist, NHS, UK.

Dr. Sudipta said, “You should have a few things—irregular periods, or heavy weight gain. These are the clinical features. Along with that, you will have laboratory diagnosis. When you do the blood test, it shows whether the patient is not ovulating, which causes irregular periods. When they did the ultrasound, it was suggestive of multiple follicles in both ovaries. That is where the name comes from.”

Recent trends show that more teenagers are getting ultrasounds, and sometimes the scans report polycystic ovaries even when the full diagnostic criteria for PCOS in adolescents are not met. This has led to a rise in overdiagnosis of PCOS in teenagers.

“What basically happens with overdiagnosis is when the clinician does not take all these factors into consideration. Just based on the history of a girl coming with irregular periods, you cannot simply say she has polycystic ovaries. It has to go together—the history of irregular periods, trouble getting pregnant, or heavy bleeding, supported by lab investigations suggestive of hormonal imbalance, plus the scan,” she said.

She further explained the current trend: “More young girls are having random scans, and the sonographer tells them they have polycystic ovaries. This is leading to overdiagnosis. You cannot just rely on one factor, it has to go together.”

Another element is lifestyle changes. There is an increase in rates of weight gain among young girls, combined with awareness of PCOS, which sometimes leads to early medical treatment. Dr. Sudipta said, "More people are aware of polycystic ovaries, and more young girls are gaining weight. They are not trying a healthy lifestyle or losing weight through diet and exercise. They are starting medications very soon rather than trying lifestyle changes first. This is one of the challenges in treating polycystic ovaries."

_MSM