Asia Oceanic Society of Paediatric and Adolescent Gynaecology (AOSPAG) Congress

Introduction: PCOS affects approximately 6-10% of adolescents, typically presenting between the ages of 10 and 19 with irregular menstruation and signs of hyperandrogenism.Diagnosis is challenging due to overlap with normal pubertal changes, highlighting the need for agespecific criteria to accurately differentiate pathological features from physiological changes.This enables timely intervention and improves long-term outcomes.Case presentation: A 16-year-old girl with secondary amenorrhea, hirsutism, and obesity (BMI 31.7).Menarche occurred at 10, with few subsequent cycles.After discontinuing oral contraceptives previously used to induce menses, her periods did not resume.Investigations revealed polycystic ovarian morphology and elevated testosterone.She was treated with Provera, Diane-35, metformin, and lifestyle modifications.After three months, she reported symptomatic improvement and expressed satisfaction with her progress.Discussion: Adolescent PCOS is a prevalent endocrine disorder, particularly among individuals with obesity or features such as hirsutism and acne.However, diagnosis in this age group is complicated by the similarity of symptoms to normal pubertal development-such as irregular menstrual cycles and dermatologic changes-raising the risk of both under-and over-diagnosis.These diagnostic challenges can delay appropriate management and contribute to adverse psychological outcomes, including reduced self-esteem, anxiety, and depression.Age-specific diagnostic criteria are essential, as menstrual irregularity is common for up to three years post-menarche, and polycystic ovarian morphology on ultrasound may persist into late adolescence.Therefore, these features alone are unreliable indicators of PCOS in adolescents.Tools such as pelvic ultrasound and AMH levels are not currently recommended for diagnostic use in adolescents.Elevated serum testosterone, however, may serve as a more specific marker.It is also crucial to exclude other causes, such as thyroid dysfunction, CAH, and hyperprolactinemia.Management should be individualised; typically involves COCP with or without metformin, alongside a strong emphasis on lifestyle changes targeting weight management.Long-term care strategies should aim to prevent metabolic complications, preserve reproductive health, and support emotional well-being. Conclusion:Early recognition and tailored management of adolescent PCOS are crucial to prevent disease progression, reduce long-term complications, and improve quality of life.Prompt intervention can minimise the need for more intensive therapies later, ultimately reducing the burden on both the individual and the healthcare system.