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Early Signs of PCOS

PCOS can show up in so many ways. Sometimes the non-specific symptoms may go overlooked and hence undiagnosed. However, these early subtle signs in adolescent girls can indicate PCOS and if you suspect having PCOS, you should get it checked by a doctor.

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Posted on June 17, 2022 ·

Polycystic ovarian syndrome (PCOS) is a chronic, metabolic condition that can affect women at varied stages of their lives and is caused mainly due to an imbalance of hormonal levels – an elevated level of androgens (male hormones) and insulin levels.

Since many PCOS symptoms are non specific and are often seen in other conditions as well, PCOS often goes overlooked and hence undiagnosed.

Signs of PCOS can start as early as your teens and may often be hard to spot. If your teenage sister or daughter begins to show signs of PCOS symptoms, she should be evaluated by a physician. If a doctor thinks she has PCOS, they may refer her to a gynaecologist or endocrinologist who can make a diagnosis.

Some of the earliest, most evident and most common signs of PCOS are seen in areas like: 

  • Irregular periods
  • Weight fluctuations
  • Cystic acne
  • Excess facial or body hair

Early PCOS Symptoms

Abnormal menstrual bleeding is often the result of anovulatory (no ovulation) cycles and cause for concern if persistent. However, there is a widespread misconception that any degree of menstrual irregularity is acceptable.  So for teenagers we define irregular cycles as following:

  • After 1 yr to 3 years if cycles are < 21 days or > 45 days
  • After 1 yr post menarche > 90 days any one cycle
  • After 3 yrs post menarche < 21 days or > 35 days
  • Or if menses start late by age 15 yrs or > 3 years post breast development

Apart from irregular periods, acne is another symptom of elevated levels of male hormones. However, many teenagers have acne even without PCOS. It can therefore be difficult to determine whether or not this symptom is truly attributable to PCOS. It is recommended that girls with moderate to severe inflammatory acne, who are unresponsive to topical treatments be evaluated for elevated androgen levels before given any potent medication.

Hirsutism must also be differentiated from generalised excessive hair growth which is predominantly seen on forearms or lower legs, which is not due to androgen excess and may have an ethnic or hereditary basis. Instead, hirsutism tends to affect the chin, chest, and back and the hair is usually thicker.

You can now understand why PCOS may go overlooked for years. For example, acne is a very common occurence in adolescent girls with or without PCOS.

Diagnosing PCOS Symptoms

If your adolescent girl begins to show subtle PCOS symptoms , she should be evaluated by a doctor. Your doctor can either refer you to a gynaecologist or endocrinologist or suggest you appropriate tests.
Diagnosing PCOS involves:

  1. Understanding medical history
  2. Complete physical examination
  3. Questions about period cycle
  4. Blood tests to check insulin, androgen, lipid levels

Not all women or girls, may meet all the diagnostic criteria criteria immediately. Some may develop obvious symptoms later or have a higher risk of developing it in adulthood.

Diagnosing PCOS requires two of these three findings:

  1. Irregular periods
  2. Symptoms such as excess facial/body hair, scalp hair loss, acne or blood test showing elevated androgen levels
  3. Ultrasound scans showing 20 or more follicles on one or both the ovaries

Why is it Important to Start PCOS Treatment Early?

While PCOS has no cure, it’s symptoms are manageable with proper medical treatment. And diagnosing PCOS is the first step in your treatment journey because understanding the root cause of your PCOS and getting the right care, greatly reduces the chances of adolescent girls from developing serious complications in the future such as:

  1. Obesity
  2. Type 2 diabetes
  3. Heart conditions
  4. Endometrial cancer
  5. Fertility issues
  6. Sleep apnea

Having an open conversation with your doctor about what the treatment journey will look like and what are her options moving forward can help you and your daughter/sibling better understand how she can manage her condition.

In today’s age, considering the drastic shifts in lifestyle, more and more female  teens, young adults and adults are being diagnosed with PCOS. Even young girls who are hitting puberty often experience symptoms of pre-PCOS, putting them at risk toward severe complications.

So as you can see PCOS is a complex condition that presents itself at various degrees. Although it is important to treat early signs of PCOS in adolescent girls, it’s also important to rule out other causes of irregular periods, acne and excess hair to avoid being misdiagnosed. Often times, the symptoms can be treated even if the diagnosis is deferred until adulthood.

Disclaimer: Content on Veera is provided for informational purposes only and is not intended as medical advice, or as a substitute for medical advice given by a physician

Verified by Dr. Iris Lee

Fellow in Reproductive Endocrinology and Infertility, University of Pennsylvania

Dr. Lee is a fellow in reproductive endocrinology and infertility at the University of Pennsylvania. She completed medical school and residency training at the University of Pennsylvania as well. Her work focuses primarily on PCOS, particularly the metabolic and mental health implications. Outside of work, she enjoys baking, reading, and spending time with her husband and two puppies.

BY Team Veera

Medically Reviewed



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