The Management of Polycystic Ovary Syndrome in Adolescents with Obesity

Adolescence marks a transition between childhood and adulthood, a time of change and turbulence in which the hypothalamo-pituitary gonadal (HPG) axis activates, acting as a harbinger for the development of secondary sexual characteristics, thelarche and menarche in girls, growth and development of bone and skeletal muscle, psychosocial and identity development. Contemporaneous with these changes, adolescence coincides with heightened peer pressure to conform to social norms, academic pressure, and impending exams. This rite of passage into adulthood is like a white-water ride, at a time when the brain is still in development (with compromised ability to make rational and sensible decisions due to relative immaturity of the frontal lobes). To accommodate increased nutritional needs, there is enhanced appetite during adolescence. In the context of our modern-day obesogenic environment with an abundance of cheap (and often addictive) ultra-processed foods, weight gain is common. In adolescent girls, weight gain and the development of obesity can result in the clinical manifestation of polycystic ovary syndrome (PCOS), in those with a genetic predisposition. Our management approach to this challenging subgroup of patients needs to adopt holism and compassion. Mental health problems (including covert bullying in virtual spaces, hidden from adult view and management) are common and not always openly expressed. These require effective and timely management from appropriately trained healthcare professionals. Effective and sustained weight loss, including the adoption of healthy lifestyle behaviours (including improved diet), remains key. However, challenges exist that include age restrictions to pharmacotherapies and bariatric surgical approaches for obesity management. Furthermore, adolescence seems marginalized in healthcare settings (with notable exceptions). We need to prioritize adolescence in our future healthcare provision and infrastructure development, including proactivity for the future secondary school. Moreover, we need environmental and cultural change and reform.