Evaluation and Management of Polycystic Ovarian Syndrome (PCOS) in Adolescents With Obesity: A Scoping Review of National and International Obesity and PCOS Management Guidelines.
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INTRODUCTION: Polycystic ovarian syndrome (PCOS) is commonly associated with obesity and has cardio-metabolic, reproductive, and psychiatric comorbidities. PCOS in adolescents is challenging to diagnose. Appropriate screening for PCOS among adolescents with overweight/obesity is essential for timely diagnosis and management. OBJECTIVE: A PRISMA-compliant scoping review of international and national pediatric obesity (n = 32) and adolescent PCOS (n = 6) management guidelines was performed to evaluate recommendations on PCOS screening and management in adolescents. METHODS: 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.