Menstrual Disorders and Hyperandrogenism in Adolescence

The approach to adolescent menstrual dysfunction must be different from that in adult women, as pubertal timing and events must be taken into consideration in diagnosis and management. Acquired or congenital disorders of the genital tract may underlie primary amenorrhea. Acquired or congenital anovulatory disorders of the hormonal cascade regulating ovary function and estrogen production may delay or arrest puberty or cause menstrual disorders (primary amenorrhea, secondary amenorrhea, oligomenorrhea, or excessive uterine bleeding). Hypogonadism may be primary or secondary and cause pubertal delay or menstrual disorders. Hyperandrogenism is a cause of menstrual disorders in adolescents, with polycystic ovary syndrome (PCOS) being the most common cause. Elevated serum testosterone level by high-specificity methodology is the cornerstone for diagnosing hyperandrogenism. Adrenal causes of hyperandrogenism must be excluded before PCOS can be diagnosed. Treatment of adolescent menstrual dysfunction is targeted to the underlying cause. Oral contraceptive medications are the cornerstone of treatment for the menstrual abnormalities and hyperandrogenism of adolescent PCOS, with antiandrogen treatment as an adjunct to treat cutaneous manifestations that are bothersome. Metformin is indicated for the treatment of glucose intolerance or diabetes mellitus in girls with PCOS, but is not primary treatment.