TABLE 51.2 CRITERIA FOR THE DIAGNOSIS OF POLYCYSTIC OVARY SYNDROME Rotterdam (2003) Requires two of three Androgen Excess Society (2009) Oligo- or anovulation Hyperandrogenism: hirsutism and/or hyperandrogenemia Clinical or biochemical signs of hyperandrogenism Ovarian dysfunction: oligoanovulation and/or polycystic Polycystic ovaries and exclusion of ovaries other etiologies Exclusion of other androgen excess or related disorders Adapted from The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome Fertil Steril 2004;81(1):19–25 Adapted from Azziz R, Carmina E, Dewailly D, et al The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report Fertil Steril 2009;91(2):456–488 Treatment goals for adolescent patients with PCOS are to restore monthly menstrual cycles, to minimize hirsutism, to prevent the development of endometrial hyperplasia, and, it is hoped, to reduce the long-term risks of relative infertility, glucose intolerance, endometrial adenocarcinoma, and cardiovascular morbidity Weight reduction, a challenging health issue in itself, can ameliorate the endocrinologic derangements and promote ovulation and regular menstruation in obese teens with PCOS, but few adolescents are able to achieve or to maintain substantial weight loss The appropriate treatment of adolescents who not desire pregnancy is a combined estrogen–progestin method which is available in a variety of delivery systems (pill, ring, or patch for example)—to suppress ovarian or adrenal androgen production and to produce monthly menstrual bleeding In adults, metformin has been used to treat PCOS by increasing peripheral tissue sensitivity to insulin Spironolactone and other antiandrogenic medications have also been used in the treatment of PCOS The practitioner should keep in mind that ovulatory cycles can potentially be restored with the use of metformin or antiandrogenics Any adolescent who is sexually active with males should be counseled about contraceptive methods, regardless of whether she has PCOS or not Initiation of these second-line therapies should be left to outpatient specialists such as gynecology or adolescent medicine