Evaluation and Management of Polycystic Ovarian Syndrome (PCOS) in Adolescents With Obesity: A Scoping Review of National and International Obesity and PCOS Management Guidelines

Databases searched included PubMed, MEDLINE, Embase, and CINAHL. Data were extracted from guidelines using a predefined extraction template. Guideline quality was appraised using the AGREE-II instrument. Fourteen (of 32) pediatric obesity guidelines included some recommendations for PCOS evaluation, whereas six incorporated management recommendations. A summary of recommendations from reviewing PCOS-specific guidelines is that all adolescent females with overweight/obesity should be evaluated for PCOS, including a comprehensive menstrual history and clinical evaluation for hirsutism and severe acne. Free testosterone is helpful for PCOS diagnosis; ovarian ultrasound is not routinely recommended. Treatment of adolescent PCOS includes weight loss through multicomponent lifestyle or adjunct antiobesity pharmacotherapy, whereas off-label use of combined oral contraceptives and metformin may be indicated for PCOS-specific symptoms. Clear recommendations on PCOS in obesity guidelines are important to improve outcomes for this condition.