Evaluation of the association of endometrial thickness, insulin resistance and menstrual patterns in adolescent females with polycystic ovarian syndrome.

STUDY OBJECTIVE: To evaluate endometrial stripe (EMS) thickness and its association with menstrual pattern and insulin resistance in adolescent females with or at risk for polycystic ovarian syndrome (PCOS).

METHODS: A retrospective case-control study of adolescent females ranging between 12-21 years old evaluated in the Adolescent Gynecology & Endocrinology Clinic (AGEC) at a tertiary children's hospital between 2017-2021. Transabdominal pelvic ultrasound (US) was obtained for evaluation of PCOS or acute pelvic pain. Unadjusted comparisons were performed between imaging measurements in the PCOS group and control (non-PCOS girls with acute pelvic pain) group, as well as analysis of the PCOS group adjusted for age, body mass index, race, and biochemical values. This study was approved by the Institutional Review Board.

RESULTS: In our study 54 subjects met inclusion criteria for the PCOS group and 42 for the control group. EMS thickness was thinner in the PCOS group than control (0.55 ± 0.31 cm vs. 0.70 ± 0.23 cm, p<0.001). There was no difference in EMS thickness in the PCOS group when stratified by intermenstrual interval, insulin resistance and other biochemical factors.

CONCLUSIONS: Our findings support recommendations by the 2018 International Guidelines to avoid use of US for the establishment of PCOS diagnosis in adolescents. These results highlight the unique pathophysiology of adolescent PCOS in contrast to PCOS in adult women. Further large-scale prospective studies are needed to understand the role of EMS thickness as a prognostic marker in adolescent PCOS.