Primary amenorrhea as a manifestation of polycystic ovarian syndrome in adolescents: a unique subgroup?

Arch Pediatr Adolesc Med. 2008 Jun;162(6):521-5. doi: 10.1001/archpedi.162.6.521.


Objective: To compare clinical and metabolic features of adolescents having primary amenorrhea (PA) and polycystic ovarian syndrome (PCOS) with those having oligomenorrhea or secondary amenorrhea (OM/SA) and PCOS.

Design: Retrospective case-control study.

Setting: Endocrine Gynecology Clinic at The Hospital for Sick Children, Toronto, Ontario, Canada.

Patients: Girls and young women aged 14 to 18 years having PA and PCOS (n = 9) seen during a 2(1/2)-year period were compared with control subjects having OM/SA and PCOS (n = 18) randomly selected during the same period.

Intervention: Medical record review was performed to assess clinical, biochemical, and ultrasonographic measures, as well as response to a progesterone challenge.

Main outcome measures: Differences in response to the progesterone challenge, hyperandrogenism, and the presence of features of the metabolic syndrome.

Results: Compared with adolescents having OM/SA, adolescents having PA demonstrated older age at pubarche, higher androstenedione levels, greater prevalence of family history of obesity, a tendency toward no withdrawal bleeding in response to the progesterone challenge, and more features associated with the metabolic syndrome (acanthosis nigricans, higher diastolic blood pressure, and lower high-density lipoprotein cholesterol level). No significant correlation was demonstrated between response to the progesterone challenge, metabolic features, and androstenedione levels.

Conclusion: Adolescents with PA and PCOS exhibit increased features of the metabolic syndrome and higher androstenedione levels and may represent a more severe spectrum of a common condition.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Age Factors
  • Amenorrhea / etiology*
  • Amenorrhea / physiopathology
  • Androstenedione / blood*
  • Case-Control Studies
  • Female
  • Health Status Indicators
  • Humans
  • Hyperandrogenism / epidemiology*
  • Hyperandrogenism / physiopathology
  • Metabolic Syndrome / epidemiology*
  • Metabolic Syndrome / physiopathology
  • Ontario / epidemiology
  • Polycystic Ovary Syndrome / complications*
  • Polycystic Ovary Syndrome / physiopathology
  • Progesterone
  • Retrospective Studies
  • Risk Factors


  • Androstenedione
  • Progesterone