UJIAN TENGAH SEMESTER

MAKALAH JURNAL ASEAN BIOLOGI REPRODUKSI DENGAN

‘JUDUL POlYCYSTIC OVARIAN SYNDROME IN ADOLESCENT
/SINDROME OVARIAN POLIKISTIK (pcos) PADA REMAJA ’ UNTUK
MEMENUHI SYARAT PEROLEHAN NILAI DALAM PROGRAM
PENDIDIKAN SARJANA TERAPAN

Dosen Nurlia R, M.Kes

Disusun Oleh:
1. Fatimah
2. Fitri Yanti Nurkhasanah
3. Luckyana Indah
4. Nina Parera Zainal
5. Susana
6. Siti Aisyah Dermawan

POLITEKNIK BHAKTI ASIH PURWAKARTA

2023

KATA PENGANTAR

Puji dan syukur kami ucapkan atas kehadirat Allah SWT atas limpahan rahmat dan karunia-Nya
kepada kami, sehingga kami dapat menyelesaikan Makalah Tugas Jurnal Asean/Eropa yang berjudul
“Policystic syndrome ovarian in adolescent/polikistik sindrome ovarium (pcos) pada remaja ” ini dengan
lancar. Penulisan makalah ini bertujuan untuk memenuhi salah satu tugas mata kuliah BIOLOGI
REPRODUKSI Makalah Jurnal ini ditulis dari hasil penyusunan data-data yang kami peroleh dari Aplikasi
internet Jurnal Asean “Rdiscovery”. Tak lupa kami mengucapkan terima kasih kepada dosen mata kuliah
BIOLOGI REPRODUKSI atas bimbingan dan arahan dalam penulisan makalah ini, sehingga dapat
diselesaikan dengan semestinya. Selanjutnya kami menyadari bahwa makalah ini belum sepenuhnya
sempurna. Tentu banyak kekurangan, semata mata kekurang mampuan kami, dalam penulisan bahasa
penerjemahan dan materi kritik saran masih kami butuhkan dalam pembuatan makalah tugas UTS jurnal ini
supaya agar lebih baik Dalam penulisan makalah ini.
Demikian kami ucapkan terimakasih sebanyak banyaknya dan semoga kami semua mendapatkan
manfaatnya.

Bekasi, November 2023

Penyusun

Abstrak
Sindrom olycysticovarians (PCOS) adalah rangkaian penyakit metabolik, reproduktif, dan psikologis
yang kompleks. Kelainan yang berdampak pada wanita sepanjang masa hidup. PCOS adalah gangguan
keseimbangan hormon.Terjadi pada wanita usia reproduktif. Gangguan ini ditandai dengan tingginya kadar
androgen pria seperti testosteron. Hal ini dapat menyebabkan gejala seperti menstruasi tidak teratur, amenore
(tidak adanya menstruasi). Anovulasi (tidak adanya ovulasi), hirsutisme, jerawat, dan obesitas. PCOS juga
menyebabkan gangguan metabolisme. Beberapa folikel matang yang tersusun secara perifer dengan diameter
sekitar 2-5 mm terdapat di ovarium. Folikel-folikel ini tidak matang karena keseimbangan hormonal yang
menyebabkan siklus menstruasi tidak teratur. PCOS adalah serangkaian gangguan kompleks metabolik,
reproduksi, dan psikologis yang berdampak pada wanita secara keseluruhan. Masa hidupnya. Sindrom
polikistikovarium bukanlah gangguan yang mengancam jiwa karena komplikasi utamanya adalah infertilitas.
PCOS dapat menjadi akar penyebab kondisi medis yang serius seperti obesitas, hipertensi, tipe-2 Diabetes
melitus karena resistensi insulin, kanker endometrium, kanker ovarium, dll. Stres dapat menyebabkan, Kadar
hormon di hipofisis berfluktuasi. Karena siklus menstruasi berbasis hormon, terdapat ketidakteraturan yang
nyata.

PENDAHULUAN

Latar Belakang

Kelainan polikistikovarium atau sindrom polikistikovarium (PCOS) adalah kelainan yang tersebar
luas disertai gangguan metabolisme endokrin. Patofisiologi penyakit ini kompleks dan menunjukkan
interaksi antara keduanya. Perubahan genetik, gangguan ovarium primer, perubahan neuroendokrin, endokrin
dan metabolik predisposisi, hiperinsulinemia, obesitas, dan tingkat resistensi insulin dan diponektin. Gejala
umum yang terlihat pada pasien adalah jerawat, hirsutisme, siklus menstruasi tidak teratur selama dua tahun
sejak menarche, dan hiperandrogenisme. Aspek kesuburan dan transisi pada remaja harus ditangani kriteria
diagnostiknya meliputi ovulasi kronis, kadar androgen tinggi, dan ovarium polikistik yang digambarkan
dalam usg. Ada tiga fenotipe PCOS: (i) Hipersekresi androgen, kista di ovarium, Ovulasi sesekali, (ii)
Hipersekresi androgen dan ovulasi sesekali, dan (iii) Hipersekresi androgen dan kista di ovarium. PCOS
dapat menggambarkan komplikasi lain seperti gula tinggi tingkat, obesitas, malfungsi metabolik, dan
kesulitan hamil. Komplikasi ini adalah akibat dari Kerusakan sekresi kelenjar hipofisis, oogenesis, dan
sekresi insulin. Pemeriksaan penunjang untuk PCOS meliputi pemeriksaan fisik umum, sonografi panggul,
pemeriksaan darah untuk hormon, sejarah keluarga, dan hirsutisme. Vitamin memainkan peran penting dalam
berbagai fungsi tubuh. Vitamin B kompleks dan vitamin C membantu penyerapannya. Kromium adalah
unsur penting dalam insulin dan metabolisme gula. Penyakit ini biasanya kurang terdiagnosis atau
disalahpahami dengan kelainan lain oleh ahli endokrin. Diagnosis PCOS kontroversial. Oleh karena itu,
penilaian dan penatalaksanaan adalah penting. Tidak konsisten. Kebutuhan pemimpin remaja dengan PCOS
tidak terpenuhi secara memadai. Metformin, kontrasepsi oral, dan myoinositol untuk remaja penderita PCOS
dapat membantu. Oral Kontrasepsi yang diresepkan untuk pasien adalah progesteron sintetis dan kombinasi
progesteron-estrogen pil. Hasil menunjukkan bahwa telah terjadi peningkatan keteraturan siklus menstruasi,
penurunan Jerawat di wajah, pengurangan obesitas, penurunan kadar glukosa darah, dan peningkatan
kolesterol total dan lipoprotein densitas rendah. Namun, pengobatan hanya boleh dilanjutkan jika ada efek
samping yang berbeda. Sebelum menggunakan kontrasepsi oral, perubahan gaya hidup, pola makan, dan
indeks massa tubuh (BMI) harus dilakukan. Terapi nutrisi dan suplemen nutrisi telah memperbaiki tanda dan
gejala pasien. Ini harus menjadi pendekatan yang ideal untuk memulihkan ovulasi. Kontrasepsi hormonal
adalah lini pertama penatalaksanaan untuk ketidakteraturan menstruasi, hirsutisme, dan jerawat. Perawatan
untuk infertilitas termasuk klomifen. Gaya hidup Persarafan bermanfaat bagi obesitas dan manfaat kesehatan
lainnya. Thiazolidinediones memiliki manfaat yang baik Rasio. Myoinositolsecaraefisien membawa fungsi
ovarium normal dan meningkatkan sel telur janin Kualitas. Siklus menstruasi teratur dan gejala lainnya sudah
normal. Diperlukan waktu 4-12 bulan untuk memperbaiki kondisi dan meringankan gejala. Resolusi kista
juga telah terlihat di USG dengan pengobatan homeopati. Kasus ditindaklanjuti dengan bukti klinis dan USG.
Terdapat efek samping minimal dibandingkan pengobatan konvensional. Kontrasepsi oral gabungan juga
merupakan pengobatan yang efektif tetapi memiliki efek samping selama 16 minggu. Lisan kontrasepsi tidak
boleh diberikan kepada remaja berusia lebih dari tiga tahun. Penelitian gizi menunjukkan bahwa pola makan
harus diprioritaskan untuk pengobatan gangguan ini. Anak perempuan dengan PCOS memenuhi kriteria yang
dapat diterima. Rentang distribusi makronutrien untuk karbohidrat, lemak, dan protein. Namun, tidak ada
perbedaan yang signifikan. Dicatat dalam asupan makanan atau kualitas makanan antara wanita dengan atau
tanpa PCOS. Target intervensi diet yang memadai dan unik mendukung posisi pedoman baru untuk
menggabungkan gaya hidup sehat modifikasi untuk pengobatan.
 METODOLOGI TINJAUAN

Kami melakukan pencarian sistematis melalui PubMed dan CENTRAL pada bulan Agustus 2022
menggunakan kata kunci seperti
“PolycysticOvarianSyndrome”dan”adolescence”(((PolycysticOvarianSyndrome[Judul/Abstrak])ATAU
(PCOS[Judul/Abstrak]))OR(“sindrom polikistikovarian”[MeSHTerms])AND((“Remaja”
[Judul/Abstrak])OR(kualitas hidup[Judul/Abstrak]))OR(“remaja”[MeSHTerms]).Kami juga mencari
Referensi utama dari bibliografi penelitian yang relevan. Pencarian diperbarui pada bulan Februari 2022.
Sebanyak 353 artikel diteliti tentang penatalaksanaan PCOS pada remaja perempuan dalam kelompok usia
12-18 tahun Tahun.Strategi pencarian menggunakan istilah seperti polikistik*tambahan dengan atau PCO*,
dan menambahkan Istilah Medical Subject Headings (MeSH) dengan nama PCOS. Filter untuk uji klinis,
meta-analisis 13-18 tahun adalah
Ditambahkan. Seorang pengulas (AA) secara independen memantau studi yang diambil terhadap kriteria
inklusi, di Awal, berdasarkan judul dan abstrak, lalu bukan teks lengkap. Pengulas lain (DGF) kemudian
meninjau sekitar 20% studi ini untuk memvalidasi penyertaan studi. Perbedaan diselesaikan melalui Diskusi.

PATOFISIOLOGI
Sangat penting untuk tidak salah menafsirkan ciri-ciri pubertas yang khas dengan PCOS. Dibutuhkan sekitar
dua hingga tiga tahun agar siklus menstruasi remaja menjadi sesuai jalur atau menjadi teratur.
Faktor predisposisi pada masa kanak-kanak dan pubertas ditunjukkan pada Tabel
PCOS Non
PCOS

Faktor predisposisi Faktor genetik pemrograman sinutero ___

Masa kanak sebelum pubertas Peningkatan Kadar Hormon Anti Mullerian ___

Pubertas Adrenalin dini,hiperandrogenisme,peningkatan Jerawat,

hormon pelepas gonadotropin, frekuensi nadi, peningkatan
ovarium besar, menstruasi tidak volume
teratur,hiperinsulinemia ovarium,
resistensi
insulin pada
masa
pubertas

TABLE 1 : Table comparingPCOS

and non PCOS components
 PCOS : polycystic Ovarian
Syndrom

Table Terdapat hubungan langsung antara PCOS dan resistensi insulin. Wanita yang menderita PCOS rentan terhadap diabetes
melitus tipe-2. Gambar 1 menunjukkan PCOS menyebabkan resistensi insulin [16]

ETIOLOGI DAN PATOFISIOLOGI

PCOS mempengaruhi 5-10% wanita pada usia reproduksi, namun etiologi dan patofisiologinya masih
belum cukup dipahami. Namun, faktor genetik dan disfungsi hipotalamus dan ovarium adalah alasan utama
untuk semua gejala tersebut. Pada remaja, kriteria hiperandrogenisme dan siklus tidak teratur diperlukan
tetapi morfologi ovarium tidak termasuk karena kekhususannya yang buruk. Manifestasinya biasanya muncul
pada masa kanak-kanak dan kemudian berkembang menjadi usia remaja dan usia reproduksi. Patofisiologi
kelainan ini adalah dihipotesiskan bebas dari interaksi antara tuan rumah, genetika, lingkungan, dan agen.
Faktor lingkungan dan genetika bisa menjadi interaksi yang kompleks. Gangguan makan seperti bulimia dan
diet berulang dapat menyebabkan PCOS pada remaja. Hal ini dapat menyebabkan disregulasi epigenetik dari
Sumbu hipotalamus-hipofisis-gonad (HPG.), sehingga berdampak pada oogenesis. Stressisarisiko terkait
utama Faktor PCOS, yang kemudian dapat menyebabkan makan berlebihan, kecemasan, dan tekanan
emosional. Dokter harus mempertimbangkan pentingnya stres psikologis dan gangguan makan saat
menangani gangguan ini. Hormon mullerian (AMH) meningkat pada kelainan ini, mengubah ovulasi dengan
perubahan endokrin dan memainkan peran penghambatan dalam roleinoogenesis dan menyebabkan
penghentian follicular. Tindakan penghambatan AM pada produksi aromatase yang diinduksi oleh hormon
perangsang folikel (FSH) kemungkinan besar menyebabkan hiperandrogenisme pada PCOS, Semakin
meningkatkan resistensi insulin pada wanita-wanita ini. Obesitas pada remaja putri dapat meningkatkan
keparahan penyakit oleh karena itu, hal ini menggarisbawahi pentingnya diagnosis dan pengobatan dini.
Disarankan untuk mendefinisikan PCOS remaja menurut kriteria konsensus rotterdam diagnosis pCOS pada
remaja putri (remaja) harus bebas dari gejala biokimia atau klinis hiperandrogenisme dan ketidakteraturan
dalam siklus menstruasi. Namun, diagnosis harus dipisahkan sampai setidaknya dua tahun setelah awal siklus
menstruasi pertama karena gejala-gejala ini mungkin juga terjadi. Terkait dengan perkembangan pubertas
normal. Sampai saat itu, tujuan utama harus mengelola gejala. PCOS adalah gangguan yang kompleks dan
multifaset dan harus didiagnosis dan diobati pada anak perempuan puber setelahnya. Mempertimbangkan
gambaran diagnosis pasien yang lengkap, risiko metabolik, dan kekhawatiran individu sehingga keduanya
dapat menghindari diagnosis yang berlebihan dan belum mampu memberikan pengobatan dini dan bermakna.
Perdarahan uterus yang tidak normal merupakan keluhan ginekologi yang paling rutin pada remaja putri.
Pasien sering mengeluh berat dan berkepanjangan. Perdarahan menstruasi. Banyak penyakit mematikan
seperti hipotiroidisme, hiperprolaktinemia, dan hiperandrogenisme Kemungkinan menjadi penyebab
perdarahan uterus abnormal. Hal ini dapat dikendalikan melalui kontrasepsi oral dan Suplementasi zat besi.
Meskipun penyebab PCOS tidak diketahui, diketahui heterogen Kelainan yang mungkin melibatkan faktor
genetik dan lingkungan yang berkontribusi terhadap ekspresi fenotipiknya. Bahan kimia pengganggu
endokrin yang dikenal dengan nama bisphenolA(BPA) menyebabkan PCOS. Peningkatan bisphenol
Konsentrasinya terlihat pada wanita remaja dan dewasa yang menderita PCOS dibandingkan dengan orang
yang sehat dan reproduktif Dan berkorelasi positif dengan hiperandrogenemia, yang menunjukkan
pentingnya bahan kimia. pemeriksaan rutin dan pengawasan ketat diperlukan untuk setiap tahap.

KOMPLIKASI
PCOS dapat menyebabkan peningkatan tekanan pada siklus menstruasi atau amenore primer atau
sekunder. Ifitis Disertai hirsutisme dan jerawat, harus dilakukan pemeriksaan laboratorium. Pemeriksaan
hormon seperti FSH, Hormon luteinisasi, hormon perangsang tiroid, prolaktin, kadar androgen dari hipofisis,
dan Insulin dari pankreas harus diukur. Prioritasnya harus pada pemulihan ovulasi, menstruasi Restorasi
siklus, dan pencegahan komplikasi jangka panjang. Ada kemungkinan besar peningkatan Risiko depresi,
kecemasan, gangguan obsesif-kompulsif (OCD), dan somatisasi. Skrining untuk hal-hal ini gangguan
mungkin diperlukan untuk memungkinkan intervensi din. Saat mendiagnosis PCOS pada remaja, gangguan
yang meniru PCOS harus dihilangkan. Gadis-gadis muda dengan PCOS harus ditindaklanjuti secara teratur
untuk mengetahui adanya komplikasi jangka pendek dan jangka panjang, bahkan pada usia dewasa pasien
dengan kelainan ini berisiko tinggi terhadap penyakit kardiovaskular dan gangguan metabolik. Penyelidikan
genetik terbaru menemukan banyak lokus yang dekat dengan gen yang terlibat dalam metabolisme, ovarium
Fungsi, dan produksi gonadotropin. Meskipun ada tantangan yang diberikan oleh fenotipik dan genetik
Variasi di antara wanita yang menderita PCOS, penelitian di satu lokasi, Agen DENND1, memberikan
sedikit penjelasan Asal usul steroid ovarium. Telah lama dipahami bahwa AMH memberikan kontribusi yang
signifikan terhadap ovarium Disfungsi.Penelitian hewan terbaru menunjukkan bahwa AMH merangsang
peningkatan hormon pelepas gonadotropin Dan pelepasan hormon luteinisasi, yang menghubungkan
ketidakstabilan AMH toneuroendokrin perubahan gaya hidup dapat membantu pasien PCOS yang menderita
depresi, konsekuensi yang parah. Seratus tujuh puluh empat Perempuan dengan PCOS adalah subjek studi
cross-sectional, dan data dikumpulkan untuk digunakan Sosiodemografi, Profil gaya hidup promosi
kesehatan, dan Inventarisasi Depresi Beck-II Kuesioner. faktor pola makan, hubungan interpersonal,
perkembangan spiritual, stres Manajemen, BMI, dan stres yang dirasakan akibat penyakit menyebabkan
gejala yang semakin parah. Dalam gaya hidup diperlukan untuk mengurangi depresi. Karena PCOS memiliki
definisi klinis yang relatif baik, penanda biokimia, dan radiologi pada wanita dewasa, gejala pada remaja
mungkin tumpang tindih dengan Orang-orang yang berada pada masa pubertas normal, membuat diagnosis
menjadi menantang. Sangat penting untuk membedakan antara masa remaja dan hiperandrogenisme
realovarian, keduanya meningkatkan risiko masalah kardiovaskular Ketika remaja perempuan menerima
intervensi gaya hidup seperti nutrisi dan olahraga, tingkat hormon fluteinisasi dan indeks androgen bebas
(FAI) mereka meningkat secara signifikan dibandingkan dengan kondisi awal. Selain itu, hal ini Penelitian
menunjukkan bahwa perubahan pola makan saja berkaitan dengan penurunan BMI yang cukup besar.
Perubahan signifikan pada kadar menstruasi, AMH, dan triasilgliserol (TAG) berkaitan dengan program
olahraga. Sekitar 11-21% wanita usia subur menderita PCOS dan sekitar 75% menunjukkan
polikistikovarium pada ultrasonografi. Dokter harus menunjukkan fenotipe pasien ketika menyimpulkan
diagnosis. Ini sangat kompleks,Kelainan poligenik yang bersifat multifaktorial dan sangat diturunkan. Risiko
jangka panjang meliputi perubahan suasana hati, psikoseksual Kelainan,kemungkinan keganasan
ovarium,tipe endometriumdankarsinoma,kardiovaskulardan Gangguan serebrovaskular, tekanan darah tinggi,
kesuburan dan komplikasi obstetrik, intoleransi glukosa, Diabetes melitus tipe-2, stenosis hati, dan malfungsi
metabolik.

DISKUSI DAN PENCEGAHAN

Sebuah studi dilakukan oleh Studi Longitudinal Australia tentang Kesehatan Wanita yang membandingkan
wanita dengan atau Tanpa PCOS yang didiagnosis sendiri. Hasil utamanya adalah wanita yang melaporkan
PCOS, bila dibandingkan dengan Wanita yang tidak melaporkan PCOS, memiliki prevalensi kecemasan,
depresi, dan stres yang lebih tinggi. Bahkan setelah penyesuaian Berdasarkan BMI, infertilitas, dan faktor
sosiodemografi, wanita dengan PCOS masih lebih mungkin mengalami kecemasan, Mengalami depresi, dan
stres. Banyak perempuan muda yang mengidap PCOS namun tidak menyadarinya. Tujuh puluh persen
perempuatidak terdiagnosis. Penyebab utama PCOS adalah gangguan efisiensi insulin atau rendahnya kadar
insulin sejak masa kanak-kanak. Ada beberapa penyebab sekunder, seperti faktor lingkungan, status sosial
ekonomi, gizi buruk dan tidak sehat, konsumsi alkohol, dan kebiasaan merokok. PCOS dengan cepat menular
Secara genetis. Wanita yang menderita PCOS bisa saja menjadi subfertil dan secara genetis dapat
menularkan kelainan ini, Sementara pasangan pria bisa saja subur. Penelitian menunjukkan bahwa
polimorfisme nukleotida tunggal tidak signifikan Terkait dengan risiko genetik PCOS dengan asosiasi dalam
tiga lokus telah digambarkan. Remaja yang memiliki PCOS tidak harus mandul pada usia reproduksinya. Hal
ini karena mereka berovulasi secara spontan. Namun, Frekuensi ovulasi tidak diketahui secara pasti, namun
penelitian menunjukkan bahwa wanita dengan PCOS berovulasi 32% dari total ovulasi mereka. Pemeriksaan
pola rambut kemaluan dan ketiak secara keseluruhan wajib dilakukan selama Diagnosis PCOS mungkin
menunjukkan pola falopecia (rambut rontok) tertentu. Alopecia bisa menjadi tanda penting dari Gangguan
hormonal, juga dikenal sebagai alopecia androgenik [41]. PCOS adalah gangguan gaya hidup yang sering
dikaitkan dengan pertambahan berat badan dan obesitas, yang meningkatkan keparahannya. PCOS. Oleh
karena itu, manajemen berat badan mencakup penurunan berat badan yang sederhana, pemeliharaan berat
badan, dan pencegahan Pertambahan berat badan kehamilan yang berlebihan. Meskipun pedoman berbasis
bukti tepat, kompleksitas, intensitas, dan Perubahan perilaku yang terkait dengan intervensi gaya hidup tidak
dipahami dengan baik pada PCOS. Di seluruh dunia, teori perilaku, pola perubahan, dan korelasi psikologis
antara pengelolaan berat badan telah dieksplorasi secara menyeluruh pada populasi umum, yang mencakup
keduanya. Dan wanita perinatal. Hasil dari semua intervensi berhubungan dengan perilaku dan psikologis.
Strategi, termasuk pemantauan diri, restrukturisasi kognitif, dan pencegahan kekambuhan.
(Concuslions) gegar otak
Remaja mengalami perubahan emosional yang sangat besar selama masa pubertas. Hal ini menyebabkan
stres , terutama pada wanita muda yang menunjukkan pertumbuhan yang cepat. Bebas stres merupakan
aspek penting dari pengobatan gangguan ini. Berkomunikasi secara terbuka dengan teman dan keluarga dapat
memberi pasien kekuatan dan rasa dukungan dalam menghadapi komponen psikologis dan emosional dari
sindrom ini. Pengelolaan gejala dan komplikasi jangka panjang pada remaja sangat penting. Konseling dan
terapi Membantu dalam manajemen stres dan dengan demikian dalam mengelola beberapa dari beberapa
gejala. Ada pengenalan tanda-tanda Dan gejala PCOS bahkan sebelum masa remaja adalah hal yang penting.
Berbagai jenis pengobatan dapat mengatasi gejalanya tetapi kondisi ini tidak dapat disembuhkan. Ini bersifat
kronis Kelainan yang dapat berlangsung selama bertahun-tahun atau pada usia reproduksi utuh. Harus ada
diagnosis yang menyeluruh Melalui ultrasonografi, tes darah untuk hormon, evaluasi fisik dan psikologis
lengkap dan Pemeriksaan, dan sering check-up. Bisa saja ada stigma buruk di sekitar wanita karena memiliki
banyak rambut di wajah karena kelebihan hormon pria, kesulitan menurunkan berat badan, dan jerawat. Ada
rambut rontok dan nyeri panggul. Remaja berisiko tinggi jika memiliki gaya hidup yang tidak sehat. Jadi,
PCOS adalah kondisi umum yang bisa bertahan lama. Istilah komplikasi jika tidak terdiagnosis dan tidak
diobati. Diagnosis dini dan pengobatan cepat dapat meningkatkan kualitas hidup dan kesuburan remaja
wanita.
Cureus Open Access Review
Article DOI: 10.7759/cureus.34183

Received 09/14/2022
Review began 10/17/2022
Review ended 01/15/2023
Published 01/25/2023 Polycystic Ovarian Syndrome in Adolescents
Copyright 2023
Adone et al. This is an open access article Avanti Adone 1,Darshna G. Fulmali 2
distributed under the terms of the Creative
Commons Attribution License CC-BY
1. Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences,Wardha,IND 2. Anatomy, Jawaharlal
4.0.,which permits unrestricted
use,distribution,and reproduction in any Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
medium, provided the original author and
source are credited.
Corresponding author:Avanti Adone, avantiadone@gmail.com

Abstract
Polycystic ovarian syndrome (PCOS) is a metabolic, reproductive, and psychological complex series of disorders that impacts a
woman throughout her lifespan. PCOS is a disorder of hormonal imbalance occurring in women of reproductive age. This disorder
is characterized by high levels of male androgens like testosterone. This can lead to symptoms like irregular periods, amenorrhea
(absence of menstruation),anovulation (absence of ovulation), hirsutism, acne, and obesity. PCOS also causes metabolic
impairment.Multiple peripherally arranged immature follicles of about 2-5mm in diameter are present in the ovary.These follicles
do not mature due to hormonal imbalances leading to an irregular menstrual cycle.PCOS is a metabolic, reproductive, and
psychological complex series of disorders that impacts a woman throughout her lifespan.Polycystic ovarian syndrome is not a
fatal or life-threatening disorder as its main complication is infertility. PCOS can be a root cause of serious medical conditions like
obesity, hypertension, type-2diabetes mellitus due to insulin resistance, endometrial cancers, ovarian cancer, etc. Stress may
cause the hormone levels in thepituitary to fluctuate. Since the menstrual cycle is hormone-based,there are apparent
irregularities.

Categories:Endocrinology/Diabetes/Metabolism, Internal Medicine, Obstetrics/Gynecology

Keywords: obesity,hormone levels, stress, irregular menstrual cycle,physical diagnosis,hyperandrogenism,genetics,hirsutism,young adolescents,s:polycystic ovary syndrome

Introduction And Background

Polycystic ovarian disorder or polycystic ovarian syndrome (PCOS) is a widespread disorder with endocrine-
metabolic impairment [1]. The pathophysiology of this disease is complex and shows the interactions of
genetic alterations, primary ovarian disruptions, neuroendocrine changes,endocrine and metabolic
predisposition,hyperinsulinemia, obesity, and resistance insulin resistance and adiponectin levels. The
common symptoms seen in patients are acne, hirsutism, irregular menstrual cycle for two years since
menarche, and hyperandrogenism. Fertility aspects and transition with adolescents must be handled [2].The
diagnostic criteria include chronic anovulation, high androgen levels, and polycystic ovaries depicted in the
ultrasound [3.There are three phenotypes of PCOS:(i) Hypersecretion of androgens,cysts in the ovary,
occasional anovulation,(ii) Hypersecretion of androgens and occasional anovulation, and (iii)
Hypersecretion of androgens and cysts in the ovary. PCOS can depict other complications like high sugar
levels, obesity, metabolic malfunction, and difficulty in conceiving. These complications are a result of the
malfunction of pituitary gland secretion, oogenesis,and insulin secretion.

The investigations for PCOS include general physical examination,pelvic sonography,blood test for
hormones, family history, and hirsutism [4]. Vitamins play a significant role in the various functions of the
body.Vitamin B complex and vitamin C help in iron absorption. Chromium is a crucial element in insulin
and sugar metabolism [5].This disease usually is underdiagnosed or misunderstood with other disorders by
endocrinologists [6]. The diagnosisof PCOS is controversial. Therefore, assessment and management are
inconsistent.The need of female adolescents with PCOS are not being adequately met [7].Drugs like
metformin,oral contraceptives,and myoinositol for adolescents with PCOS can be helpful.Oral
contraceptives prescribed to the patient are synthetic progesterone and combined progesterone-estrogen
pills.Results show that there has been improvement in the regularity of the menstrual cycle,reduction in
acne of the face,reduction of obesity, reduction in blood glucose level, and improved total cholesterol and
low-density lipoprotein.However,treatment should only be continued if fewer side effects exist [8].Before
using oral contraceptives, lifestyle, dietary, and body mass index (BMI) changes should be made. Medical
nutrition therapy and nutritional supplements have improved patients' signs and symptoms. This should be
an ideal approach to restoring ovulation [9]. Hormonal contraceptives are the first line of management for
menstrual irregularties, hirsutism, and acne. Treatment for infertility includes clomiphene.Lifestyle
innervation is beneficial for obesity and other health benefits [10].Thiazolidinediones have a good benefit
 ratio. Myoinositol efficiently brings about normal ovarian function and improves the fetus's ovumand
quality [11].The irregular menstrual cycle and other symptoms have normalized. It takes 4-12 months to
improve the condition and relieve the symptoms. The resolution of cysts has also been seen in the
ultrasound with homeopathic treatment. Cases were followed up with clinical and ultrasound evidence.
There are minimum side effects as compared to conventional treatment [12].

How to cite this article

Adone A,Fulmali D G (January 25,2023) Polycystic Ovarian Syndrome in Adolescents. Cureus 15(1): e34183. DOI 10.7759/cureus.34183
Cureus
Combined oral contraceptives are also effective treatments but have side effects for 16 weeks. Oral
contraceptives cannot be given to teenagers for more than three years [13].The nutritional studies showed
that diet should be prioritized for the treatment of this disorder. Girls with PCOS met the acceptable
macronutrient distribution ranges for carbohydrates,fats, and protein. However, no differences were
recorded in the food or dietary quality intake between women with or without PCOS. A deficient and unique
target for dietary interventions supports the position of new guidelines to incorporate healthy lifestyle
modifications for treatment [14].

Review
Methology
We undertook a systematic search through PubMed and CENTRAL in August 2022 using keywords such as
"Polycystic Ovarian Syndrome" and "adolescence" (((Polycystic Ovarian Syndrome [Title/Abstract]) OR
(PCOS [Title/Abstract])) OR (*polycystic ovarian syndrome" [MeSH Terms]) AND (("Adolescence"
[Title/Abstract]) OR (QoL [Title/Abstract])) OR ("adolescence"[MeSH Terms]).We additionally searched for
key references from bibliographies of the relevant studies.The search was updated in February 2022. A total
of 353 articles were searched about the management of PCOS in adolescent girls in the age group of 12-18
years.Search strategies were putting terms like polycystic ovarian* add with or PCO*, and adding the
Medical Subject Headings (MeSH) terms with the name PCOS.Filters for clinical trials,meta-analyses,
randomized control trials, and systematic reviews were added. Additional filters for ages 13-18 years were
added.One reviewer (AA) independently monitored the retrieved studies against the inclusion criteria,in
the beginning, based on the title and abstract and then on full texts.Another reviewer (DGF) then reviewed
approximately 20% of these studies to validate the inclusion of studies. Differences were resolved through
discussion.

Pathophysiology
It is imperative not to misinterpret typical puberty features with PCOS. It takes about two to three years for a teenager's menstrual cycle to
come on track or become regular.The predisposing factors in childhood and puberty are shown in Table 1[15].

PCOS Non-PCOS

Predisposing

Factors Genetic factors in utero programming

Childhood(
Increased anti-Mullerian hormone levels
Pre-puberty)

Premature adrenarche,hyperandrogenism,Increased gonadotropin-releasing Acne,increased ovarian volume,

Puberty
hormone, pulse frequency,bulkyovaries, irregular menses, hyperinsulinemia insulin resistance of puberty

TABLE 1:Table comparing PCOS and non-PCOS components

PCOS:polycystic ovarian syndrome

There is a direct link between PCOS and insulin resistance. Females who suffer from PCOS are susceptible to type-2 diabetes
mellitus.Figure 1 shows how PCOS leads to insulin resistance [16].
2023 Adone et al. Cureus 15(1):e34183. DOI 10.7759/cureus.34183

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FIGURE 1: Link between diabetes and polycystic ovarian syndrome

Image credit:Avanti Adone

Etiology and pathophysiology

PCOS affects 5-10% of women of reproducible age, but its etiology and pathophysiology are still not quite
understood. However, genetic factors and hypothalamic and ovarian dysfunction are the main reasons for all
the symptoms. In adolescents, both the criteria of hyperandrogenism and irregular cycles are needed but
ovarian morphology is not included due to poor specificity. The manifestations usually arise in childhood
and then evolve into adolescence and reproductive age. The pathophysiology of this disorder was
hypothesized to be based on interactions between the host, genetics, environment,and agent.
Environmental factors and genetics could be a complex interplay [17].Eating disorders like bulimia and
recurrent dieting can lead to PCOS in adolescents. They can lead to the epigenetic dysregulation of the
hypothalamic-pituitary-gonadal (HPG.) axis,thereby impacting oogenesis. Stress is a main related risk
factor for PCOS,which can then lead to overeating, anxiety, and emotional distress. Doctors should consider
the importance of psychological stress and eating disorders while dealing with these disorders [18].Anti-
Müllerian hormone (AMH) is elevated in this disorder, altering the ovulation with endocrine alterations and
playing an inhibiting role in oogenesis and presenting to follicular arrest. AMH inhibitory actin on follicle-
stimulating hormone (FSH)-induced aromatase production likely presents hyperandrogenism in PCOS,
further enhancing insulin resistance in these women [19].Obesity in teenage girls might elevate the severity
of the disease;therefore, it underlines the prime importance of early diagnosis and treatment. It may be
advisable to define adolescent PCOS according to Rotterdam consensus criteria [20].

PCOS diagnosis in young females (teenagers) must be based on biochemical or clinical symptoms of
hyperandrogenism and irregularity in the menstrual cycle. However, the diagnosis should be separated until
at least two years following the beginning of the first menstrual cycle as these symptoms may also be
associated with normal pubertal development. Until then, the main goal should be managing symptoms [21].
PCOS is a complex, multifaceted disorder and should be diagnosed and treated in pubescent girls after
considering the patient's complete diagnostic picture, metabolic risks, and individual concerns to both avoid
over-diagnosis and yet be able to provide early and meaningful treatment [22]. Abnormal uterine bleeding is
the most routine gynaecological complaint of young girls. Patients often complain about heavy,prolonged
menstrual bleeding. Many lethal diseases like hypothyroidism, hyperprolactinemia, and hyperandrogenism
are possible causes of abnormal uterine bleeding. This can be brought in control by oral contraceptives and
iron supplementation [23].Although the cause of PCOS is unknown, it is known to be a heterogeneous
disorder that might involve genetic and environmental factors contributing to its phenotypic expression.

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2023 Adone et al. Cureus15(1):e34183. DOI 10.7759/cureus.34183
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An endocrine-disrupting chemical known as bisphenol A (BPA) causes PCOS. Increased bisphenol
concentrations are seen in teenage and adult females with PCOS compared to reproductively healthy ones
and are positively correlated with hyperandrogenemia,which shows the importance of chemicals
[24].Regular check-ups and close surveillance are necessary for every stage of life,like adolescence,
reproductive age, and old age, to reduce complications and risks that could affect the patient's offspring as it
is genetically transferred[25].

Complications
PCOS could be a cause for cessation of the menstrual cycle or primary or secondary amenorrhea.If it is
accompanied by hirsutism and acne, laboratory tests should be done. Tests for hormones like FSH,
luteinizing hormone,thyroid stimulating hormone, prolactin, androgen levels from the pituitary,and
insulin from the pancreas must be measured. The priority should be the recovery of ovulation,menstrual
cycle restoration, and the prevention of long-term complications [26].There is a high chance of increased
risks of depression, anxiety, obsessive-compulsive disorder (OCD), and somatization. Screening for these
disorders may be warranted to allow early Intervention [27].While diagnosing PCOS in adolescents,
disorders that mimic PCOS should be eliminated. Young girls with PCOS should be regularly followed up for
short-term and long-term complications, even in adulthood [28].Patients with these disorders are at a high
risk of cardiovascular diseases and metabolic disorders [29].

The most recent genetic investigation found many loci close to genes involved in metabolism, ovarian
function,and gonadotropin production. Despite the challenges provided by the phenotypic and genetic
variation among PCOS-afflicted females,research on one location,the DENND1A gene, sheds light on
ovarian steroids' origins. It has long been understood that AMH contributes significantly to ovarian
dysfunction. Recent animal studies show that AMH stimulates enhanced gonadotropin-releasing hormone
and luteinizing hormone release,which link AMH to neuroendocrine instability [30].Changes in lifestyle can
help patients with PCOS who suffer from depression, a severe consequence.One hundred seventy-four
females with PCOS were the subjects of a cross-sectional study, and data were gathered using
sociodemographic, the Health Promoting Lifestyle Profile-2, and the Beck Depression Inventory-II
questionnaires [31]. The factors of diet, interpersonal relationships, spiritual development,stress
management,BMI,and the perceived stress of the illness lead to an aggravation of the symptoms.A change
in lifestyle is required to lessen depression [31]. Because PCOS has relatively well-defined clinical,
biochemical, and radiological markers in adult females, the symptoms in adolescents may overlap with
those of normal puberty, making a diagnosis challenging. It is critical to distinguish between typical
adolescence and real ovarian hyperandrogenism, both of which raise the risk of cardiovascular problems [32].

Adolescents should be concerned more with symptom management than fertility. Every young patient
should receive individualized care [33]. Teenagers who are obese require increased attention from medical
professionals and researchers, as well as beneficial early-stage interventions.Once the diagnosis of obesity
has been made, it is vital to begin a holistic approach and show care for linked comorbidities as soon as
feasible.Their weight condition substantially impacts the patient's pathophysiology [34].The characteristic
ovarian structure confirmed by ultrasound examination, elevated levels of luteinizing hormone,androgens,
prolactin, and estradiol concentration with an upper limit are the distinguishing features of PCOS in
addition to the clinical symptoms.Because of persistent anovulation and aberrant hormone balance brought
on by the high basal prolactin level, the pituitary lactotrophs output was elevated [35].This syndrome is way
more complex than it looks. Adolescent patients are already under peer pressure and mental stress.They
undergo many mood swings. Hence, handling such cases might be challenging [36].PCOS can affect self-
confidence and body image [37]. Teenagers have to cope with emotions and frustrations. Being stress-free is
a critical aspect of treating this disorder. Communicating openly with friends and family can give the patient
strength and a sense of support in dealing with the psychological and emotional components of the
syndrome.Counselling and therapy help these patients in stress management and thereby in managing
some of the few symptoms.PCOS is called a syndrome because the patient can experience many symptoms
at the same time.Therefore, the management of symptoms and long-term complications in teenagers is
essential.PCOS can affect mental health drastically as it indirectly influences body image [38].

When adolescent females receive lifestyle interventions like nutrition and exercise, their levels of luteinizing hormone and the
free androgen index (FAI) significantly improve compared to baseline. Additionally,this research showed that dietary changes
alone were linked to a considerable drop in BMI. Significant changes in menstruation,AMH,and triacylglycerol (TAG) levels were
linked to exercise programs [39].About 11-21% of women of reproductive age have PCOS and around 75% show polycystic
ovaries on ultrasonography.
Physicians must denote the patient's phenotype when concluding a diagnosis. It is a highly complex,
multifactorial,and highly inherited polygenic disorder. Long-term risks include mood swings,psychosexual
disorders, possible ovarian malignancy,endometrial atypia and carcinoma, cardiovascular and
cerebrovascular disorders, high blood pressure, fertility and obstetrics complications, glucose intolerance,
type-2 diabetes mellitus, hepatic stenosis, and metabolic malfunctions [40].

Discussion and prevention

A study was performed by the Australian Longitudinal Study of Women's Health comparing women with or
Cureus
without self-diagnosed PCOS.The primary outcome was that women reporting PCOS, when compared with
women not reporting PCOS, had a higher prevalence of anxiety, depression, and stress. Even after adjusting
to BMI, infertility, and sociodemographic factors,women with PCOS are still more likely to be anxious,
depressed,and stressed. Many young females have PCOS but are unaware of it. Seventy percent of women
are undiagnosed. The primary cause of PCOS involves a disturbance in insulin efficiency or low insulin levels
since childhood. There are multiple secondary causes, such as environmental factors, socioeconomic status,
poor and unhealthy nutrition, alcohol intake, and smoking of cigarettes. PCOS is quickly passed on
genetically.A female suffering from PCOS could be subfertile and can genetically pass on this disorder,
while the male partner could be fertile.A study shows that single nucleotide polymorphism is significantly
related to the genetic risk of PCOS with association within three loci was depicted.Adolescents having PCOS
do not need to be infertile in their reproductive age.This is because they ovulate spontaneously.However,
the ovulation frequency is not certain, but a study reveals that women with PCOS ovulate 32% of their
whole reproductive age. Pubic and axillary hair pattern examination must also be necessary during the
diagnosis.PCOS may show a certain pattern of alopecia (hair loss). Alopecia could be a vital sign of
hormonal disturbances, also known as androgenic alopecia[41].

One of the most rational treatment methods for PCOS is inositol, a dietary supplement with proven effect on
ovulation without any adverse side effects if taken in recommended doses. Alternative treatment methods
include insulin sensitizers, selective estrogen receptor modulators,and aromatase inhibitors. Among these,
the aromatase inhibitor letrozole and the combination of clomiphene citrate and metformin have the
highest rate of causing ovulation. Ovarian electrocautery and low-dose FSH stimulation are also some other
viable options.PCOS has an essential impact on other metabolism taking place in the body. It vastly affects
lipid metabolism. Therefore, the classical sign of PCOS in 50-60% of women is obesity. Obesity is associated
with hyperlipidemia (hypertriglyceridemia and hypercholesteremia). PCOS causes a litany of diseases like
infertility, insulin resistance, obesity, heart problems, and much more.It is a polygenic, multifactorial,
inflammatory,autoimmune disease that occurs largely due to lifestyle error.Due to rapid advancements in
biochemical tests and ultrasound imaging, PCOS can now be detected as early as possible.In recent times,a
considerable amount of information has been garnered on PCOS, leading to the development of
interventions like oral contraceptive pills and hormone therapy which can be used to reverse the effects of
PCOS.However,lifestyle changes remain the primary correction therapy for controlling PCOS [42].PCOS is
the leading cause of female infertility worldwide and is linked to an increased risk of diseases like type-2
diabetes mellitus, psychiatric disorders, and gynaecological cancer. Despite a large number of cases,the
main etiology of PCOS remains unknown. Although the genetic loci of PCOS account for only 10% of its
heritability,male and female relatives of women suffering from PCOS are at high risk of developing PCOS-
associated reproductive and metabolic disorders. Hyperandrogenism is the leading cause of PCOS [43].

PCOS is a lifestyle disorder often associated with weight gain and obesity, which increase the severity of
PCOS.Hence,weight management includes modest weight loss,maintenance of weight, and prevention of
excess gestational weight gain. Despite proper evidence-based guidelines,the complexity,intensity,and
behavioural changes associated with lifestyle interventions are not adequately understood in PCOS.
Throughout the world,behavioral theories, change patterns, and psychological correlations between weight
management have been thoroughly explored in the general population,which includes both reproductive
and perinatal women. The outcomes of all the interventions correlate to the behavioural and psychological
strategies, including self-monitoring, cognitive restructuring, and relapse prevention.

Conclusions
Teenagers go through extreme amounts of emotional changes during puberty. This leads to stress and
anxiety, especially in young females who show rapid growth. Being stress-free is an important aspect of the
treatment of this disorder.Communicating openly with friends and family can give the patient strength and
a sense of support in dealing with the psychological and emotional components of the syndrome.The
management of symptoms and long-term complications in teenagers is essential.Counseling and therapy
help in stress management and thereby in managing some of the few symptoms.The recognition of signs
and symptoms of PCOS even before the onset of adolescence is essential.

Various types of treatment can manage the symptoms but this condition is not curable. It is a chronic
disorder that can last for many years or a whole reproductive age. There should be thorough diagnosis
through ultrasonography,blood tests for hormones, complete physical and psychological evaluation and
examination,and frequent check-ups. There could be a stigma around females for having lots of facial hair
due to excess male hormones, trouble losing weight, and acne. There is hair loss and pelvic pain.Teenagers
are at high risk if they have an unhealthy lifestyle. Thus, PCOS is a common condition that can have long-
term complications if left undiagnosed and untreated. Early diagnosis and quick treatment can improve the
life quality and fertility of adolescent females.

Additional Information
Disclosures
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the
following:Payment/services info:All authors have declared that no financial support was received from

2023 Adone et al. Cureus 15(1):e34183. DOI 10.7759/cureus.34183

5of7
Cureus
any organization for the submitted work. Financial relationships: All authors have declared that they have no financial
relationships at present or within the previous three years with any organizations that might have an interest in the
submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could
appear to have influenced the submitted work.

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