Clinical and Ultrasound Features of Normocyclic Non-Hyperandrogenic Adolescents in Early Gynecological Life.

OBJECTIVE

This study aimed to determine the prevalence of polycystic ovarian morphology (PCOM) in healthy postmenarcheal girls and assess whether it represents a crucial physiological phase in gynecological development. Additionally, it evaluated if an elevated stromal-to-surface area (S/A) ratio could identify individuals at risk of developing polycystic ovarian syndrome (PCOS).

DESIGN

This is an observational cross-sectional study.

PARTICIPANTS

A total of 302 healthy postmenarcheal girls aged 14-18 were included in the study.

SETTING

The study was conducted at the Pediatric and Adolescent Gynecology Service of the University Hospital Duilio Casula, Monserrato, University of Cagliari, from 2020 to 2023.

METHODS

Participants were divided into three groups: normal ovarian morphology (NOM), PCOM with normal S/A ratio (PCOM-NS), and PCOM with increased S/A ratio (PCOM-IS). Anthropometric, clinical, hormonal, and ultrasound (US) characteristics were analyzed.

RESULTS

The overall prevalence of PCOM was 43% (95% CI: 0.37-0.49). Among 302 subjects, 171 (57%) exhibited NOM, 90 (30%) showed PCOM-NS, and 41 (13%) had PCOM-IS. The age and years of postmenarcheal life were significantly lower in the PCOM-NS group than in the NOM group. PCOM-NS exhibited a higher waist-to-hip ratio, hirsutism prevalence, and follicle count per ovarian section. PCOM-IS was associated with elevated androgen levels. A significant reduction in the PCOM pattern was observed after the third postmenarcheal year, while the NOM pattern increased significantly beyond 5 years postmenarche.

LIMITATIONS: The study is limited by its cross-sectional design, which precludes establishing causality. Additionally, the exclusion of certain participants due to technical limitations in US evaluation may introduce selection bias.

CONCLUSIONS

PCOM may represent a normal physiological phase in ovarian development during early adolescence, predominantly observed in the first 1-3 years postmenarche. An increased S/A ratio could help identify adolescents who may benefit from monitoring for potential PCOS development.