Update on diagnosis of polycystic ovary syndrome during adolescence

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic condition beginning during the peripubertal years. The international evidence-based guidelines, updated in 2023, have clearly defined the diagnostic criteria during adolescence with the goal of decreasing controversies and challenges with the diagnosis during this critical life stage. In this narrative review, we aimed to examine the recent available data related to the diagnosis of PCOS during adolescence. Specifically, we evaluated publications from August 2022 (date when the last searches were run for the update of the international evidence-based guidelines on PCOS) to May 2025. Current evidence supports the use of two main diagnostic criteria for adolescents: irregular menstrual cycles, well defined according to time after menarche, and hyperandrogenism, either clinical or biochemical, after excluding other conditions that mimic PCOS. In contrast to adult PCOS diagnostic criteria, polycystic ovary morphology on pelvic ultrasound and/or antimüllerian hormone levels should not be used for adolescent PCOS diagnosis. Accurate and timely diagnosis of PCOS during adolescence enables early screening and management of PCOS and its associated comorbidities. Equally important is the early identification of adolescents considered "at risk" of PCOS (those who only meet one diagnostic criterion) as emerging evidence indicated increased metabolic risks and reinforces the need for long-term follow-up. Novel cluster analysis in well-defined adolescent cohorts is beginning to clarify threshold values for diagnostic features and may further refine adolescent-specific criteria. Specific PCOS diagnostic criteria avoiding polycystic ovary morphology and antimüllerian hormone, and using of clearly defined irregular menstrual cycles and hyperandrogenism should be applied during adolescence. Early recognition of adolescents both with PCOS and those "at risk" is critical to ensure timely metabolic screening and appropriate follow-up. Health care professionals should be aware that different PCOS diagnostic criteria are necessary for adolescents.