Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a common condition that may affect your child’s reproductive health and metabolism. It happens when the body’s hormones are out of balance. PCOS can cause irregular or missed periods, acne, and extra hair on the face or body.

PCOS is often diagnosed in teens or young adults, though signs can start earlier. Over time, it may increase risk for weight gain, type 2 diabetes, or heart disease.

Doctors usually diagnose PCOS by looking at symptoms, performing a physical examination, and checking hormone levels through blood tests. With the right care — like hormone treatments, lifestyle changes, or medication — it can be managed.

Each month, the ovaries are supposed to release an egg. This is called ovulation. If the egg isn’t fertilized, the body absorbs it, and the lining of the uterus is shed during a period.

But with PCOS, the body doesn’t make the right mix of hormones to mature or release an egg. Instead, small sacs of fluid called follicles can form in the ovaries. These hold eggs that don’t fully mature or get released. When the egg doesn’t mature and get released, the body doesn’t get the proper signal that it’s time to have a period. This may lead to your child or adolescent having irregular or missed periods.

Adolescents with PCOS may experience:

• Irregular periods or missed periods: Periods may come too often, not often enough, or stop altogether. They may also be very light. These symptoms happen because the body isn’t ovulating regularly.
• Acne or oily skin: Hormone changes can cause the skin to make more oil, which may lead to breakouts, especially on the face, chest, or back.
• Extra hair on the face or body: Some people grow thicker or darker hair on their face, abdomen, or back due to higher levels of androgen hormones in their body.
• Weight gain or difficulty losing weight: PCOS can make it easier to gain weight and harder to lose it, especially around the belly area.
• Thinning hair on the scalp or male-pattern baldness: Hair on the head may become thinner or fall out in a pattern like male baldness, often due to high androgen levels.
• Dark or thick patches of skin: Skin on the back of the neck, in the armpits, or under the breasts may become darker, thicker, or feel velvety.

While we don’t yet know the exact cause of PCOS, we do know there are several factors that contribute to it developing. These include:

• Genetics (family history): PCOS tends to run in families, so if a close relative has it, the chances of your child having it are higher.
• Hormone imbalance: People with PCOS often have high levels of hormones called androgens, which can stop the ovaries from ovulating.
• Insulin resistance: Many people with PCOS are less sensitive to a hormone called insulin, as compared to other people. This can lead to high insulin levels, which may cause the body to make more androgens.

When diagnosing PCOS, we take a careful history, ask questions about your child’s symptoms, complete a physical examination, and check hormone levels. An ultrasound is not required to diagnosis PCOS in adolescents.

There’s no one-size-fits-all treatment for PCOS. Everyone living with the condition has their own unique needs, lifestyle, and experiences. The most effective care plans are tailored to each person’s concerns and are built through close collaboration between providers, patients, and families.

Some common PCOS treatment options include:

• Hormonal therapies to help regulate periods, improve acne, and reduce extra hair growth.
• Lifestyle changes, such as incorporating movement and dietary adjustments, to help balance hormones and lower the risk of other health problems like type 2 diabetes.
• Medications such as metformin to help the body become more sensitive to insulin.
• Mental health support to help patients manage stress, anxiety, or challenges with self-esteem.

The Reproductive Endocrinology and PCOS Program at Boston Children’s Hospital is dedicated to caring for patients with PCOS. Our team takes a multidisciplinary approach, offering support in areas like nutrition and mental health when needed. Clinicians with specialized training in Adolescent and Young Adult Medicine and Endocrinology bring deep expertise and understand this age group’s unique needs. We tailor treatments to meet your child’s individual needs and goals.