The difference between adolescent amenorrhea and polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common menstrual disease that occurs during adolescence and childbearing age. According to the 5%-10% prevalence reported abroad, nearly 50 million women in my country will suffer from the disease.

Some scholars believe that PCOS is an endocrine disease with metabolic disorders. After menarche in adolescence, due to imperfect feedback regulation of the hypothalamus-pituitary-ovarian axis, oligomenorrhea, amenorrhea, and irregular menstruation often occur, which are often confused with PCOS in adolescence and misdiagnosed as physiological phenomena. Therefore, those who have natural menstruation within 1-3 years of age are physiological phenomena. If the disorder persists, you should be alert to the occurrence of PCOS.

So, how to distinguish between puberty physiological phenomena and puberty polycystic ovary syndrome?

(1) Differences in androgen secretion: During normal puberty, adrenal function appears, adrenal enzyme activity increases, and adrenal androgen secretion increases. In PCOS patients, adrenal function becomes overactive and premature, which causes adrenal enzyme hyperactivation and abnormally increased androgen synthesis, leading to hyperandrogenism.

(2) Changes in ovarian morphology: During puberty, multiple follicles can be seen on the ovaries under B-ultrasound, which is very similar to puberty PCOS. Some people believe that the ovaries of PCOS patients are enlarged and the ovarian stroma echo is enhanced, but it is difficult to distinguish between the two. Therefore, simple ovarian polycystic changes without clinical symptoms cannot be diagnosed. With age, physiological polycystic changes can disappear naturally. However, PCOS will have persistent polycystic changes.

(3) Insulin resistance and compensatory hyperinsulinemia: Starting from puberty, insulin plays an important role in promoting growth under the synergistic effect of growth hormone (GH) and insulin-like factor (IGF-1). Usually, in an oral glucose tolerance test (OGTT), insulin can reach about three times that before puberty. However, PCOS patients have decreased sensitivity to insulin, insulin resistance, and metabolic hyperinsulinemia.