Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Treatment of polycystic ovary syndrome in adolescents

Robert L Rosenfield, MD
Section Editors
Amy B Middleman, MD, MPH, MS Ed
Mitchell E Geffner, MD
Deputy Editor
Alison G Hoppin, MD


Polycystic ovary syndrome (PCOS) should be considered in any adolescent girl with a chief complaint of hirsutism, menstrual irregularity, or obesity. Acanthosis nigricans, treatment-resistant acne, scalp hair loss, or hyperhidrosis may alternatively be the chief complaint, although these features are not always present (see "Definition, clinical features and differential diagnosis of polycystic ovary syndrome in adolescents", section on 'Clinical features'). PCOS is primarily characterized by ovulatory dysfunction and hyperandrogenism [1]. The diagnosis of PCOS has life-long implications with increased risk for infertility, metabolic syndrome, type 2 diabetes mellitus, and other health implications including possibly cardiovascular disease and endometrial carcinoma [2-5].

Treatment for PCOS in adolescents is primarily directed at the major clinical manifestations, which are:

Abnormal uterine bleeding – menstrual irregularity or excessive bleeding

Cutaneous hyperandrogenism – primarily hirsutism and persistent acne

Obesity and insulin resistance

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 05, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Rosenfield RL. The Diagnosis of Polycystic Ovary Syndrome in Adolescents. Pediatrics 2015; 136:1154.
  2. Shaw LJ, Bairey Merz CN, Azziz R, et al. Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health--National Heart, Lung, and Blood Institute sponsored Women's Ischemia Syndrome Evaluation. J Clin Endocrinol Metab 2008; 93:1276.
  3. Fauser BC, Bouchard P. Uncertainty remains in women with PCOS regarding the increased incidence of cardiovascular disease later in life, despite the indisputable presence of multiple cardiovascular risk factors at a young age. J Clin Endocrinol Metab 2011; 96:3675.
  4. Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman's long-term health using data linkage. J Clin Endocrinol Metab 2015; 100:911.
  5. Twig G, Yaniv G, Levine H, et al. Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood. N Engl J Med 2016; 374:2430.
  6. McCartney CR, Marshall JC. CLINICAL PRACTICE. Polycystic Ovary Syndrome. N Engl J Med 2016; 375:54.
  7. Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013; 98:4565.
  8. Witchel SF, Oberfield S, Rosenfield RL, et al. The Diagnosis of Polycystic Ovary Syndrome during Adolescence. Horm Res Paediatr 2015.
  9. Martin KA, Chang RJ, Ehrmann DA, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93:1105.
  10. Gordon CM, Pitts SA. Approach to the adolescent requesting contraception. J Clin Endocrinol Metab 2012; 97:9.
  11. Diamanti-Kandarakis E, Baillargeon JP, Iuorno MJ, et al. A modern medical quandary: polycystic ovary syndrome, insulin resistance, and oral contraceptive pills. J Clin Endocrinol Metab 2003; 88:1927.
  12. Cibula D, Sindelka G, Hill M, et al. Insulin sensitivity in non-obese women with polycystic ovary syndrome during treatment with oral contraceptives containing low-androgenic progestin. Hum Reprod 2002; 17:76.
  13. Tfayli H, Ulnach JW, Lee S, et al. Drospirenone/ethinyl estradiol versus rosiglitazone treatment in overweight adolescents with polycystic ovary syndrome: comparison of metabolic, hormonal, and cardiovascular risk factors. J Clin Endocrinol Metab 2011; 96:1311.
  14. Adeniji AA, Essah PA, Nestler JE, Cheang KI. Metabolic Effects of a Commonly Used Combined Hormonal Oral Contraceptive in Women With and Without Polycystic Ovary Syndrome. J Womens Health (Larchmt) 2016; 25:638.
  15. Lopez LM, Grimes DA, Schulz KF. Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus. Cochrane Database Syst Rev 2012; :CD006133.
  16. Visser J, Snel M, Van Vliet HA. Hormonal versus non-hormonal contraceptives in women with diabetes mellitus type 1 and 2. Cochrane Database Syst Rev 2013; :CD003990.
  17. Cremer M, Phan-Weston S, Jacobs A. Recent innovations in oral contraception. Semin Reprod Med 2010; 28:140.
  18. Elger W, Beier S, Pollow K, et al. Conception and pharmacodynamic profile of drospirenone. Steroids 2003; 68:891.
  19. Oelkers W, Foidart JM, Dombrovicz N, et al. Effects of a new oral contraceptive containing an antimineralocorticoid progestogen, drospirenone, on the renin-aldosterone system, body weight, blood pressure, glucose tolerance, and lipid metabolism. J Clin Endocrinol Metab 1995; 80:1816.
  20. Stegeman BH, de Bastos M, Rosendaal FR, et al. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ 2013; 347:f5298.
  21. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ 2015; 350:h2135.
  22. Lidegaard Ø, Løkkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ 2009; 339:b2890.
  23. Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics 2013; 131 Suppl 3:S163.
  24. Thorneycroft lH, Gollnick H, Schellschmidt I. Superiority of a combined contraceptive containing drospirenone to a triphasic preparation containing norgestimate in acne treatment. Cutis 2004; 74:123.
  25. Vose CW, Butler JK, Williams BM, et al. Bioavailability and pharmacokinetics of norethisterone in women after oral doses of ethynodiol diacetate. Contraception 1979; 19:119.
  26. Murthy AS. Obesity and contraception: emerging issues. Semin Reprod Med 2010; 28:156.
  27. Legro RS, Pauli JG, Kunselman AR, et al. Effects of continuous versus cyclical oral contraception: a randomized controlled trial. J Clin Endocrinol Metab 2008; 93:420.
  28. Benjamins LJ. Practice guideline: evaluation and management of abnormal vaginal bleeding in adolescents. J Pediatr Health Care 2009; 23:189.
  29. Rosenfield RL. Clinical review: Adolescent anovulation: maturational mechanisms and implications. J Clin Endocrinol Metab 2013; 98:3572.
  30. Okoroh EM, Hooper WC, Atrash HK, et al. Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003-2008. Am J Obstet Gynecol 2012; 207:377.e1.
  31. Bird ST, Hartzema AG, Brophy JM, et al. Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis. CMAJ 2013; 185:E115.
  32. Glintborg D, Sidelmann JJ, Altinok ML, et al. Increased thrombin generation in women with polycystic ovary syndrome: A pilot study on the effect of metformin and oral contraceptives. Metabolism 2015; 64:1272.
  33. Lidegaard Ø, Løkkegaard E, Jensen A, et al. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med 2012; 366:2257.
  34. Stachenfeld NS, DiPietro L, Palter SF, Nadel ER. Estrogen influences osmotic secretion of AVP and body water balance in postmenopausal women. Am J Physiol 1998; 274:R187.
  35. Kharbanda EO, Parker ED, Sinaiko AR, et al. Initiation of oral contraceptives and changes in blood pressure and body mass index in healthy adolescents. J Pediatr 2014; 165:1029.
  36. Venn A, Bruinsma F, Werther G, et al. Oestrogen treatment to reduce the adult height of tall girls: long-term effects on fertility. Lancet 2004; 364:1513.
  37. Woods KS, Reyna R, Azziz R. Effect of oral micronized progesterone on androgen levels in women with polycystic ovary syndrome. Fertil Steril 2002; 77:1125.
  38. Bagis T, Gokcel A, Zeyneloglu HB, et al. The effects of short-term medroxyprogesterone acetate and micronized progesterone on glucose metabolism and lipid profiles in patients with polycystic ovary syndrome: a prospective randomized study. J Clin Endocrinol Metab 2002; 87:4536.
  39. Fournier A, Berrino F, Riboli E, et al. Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Int J Cancer 2005; 114:448.
  40. Yager JD, Davidson NE. Estrogen carcinogenesis in breast cancer. N Engl J Med 2006; 354:270.
  41. Pastor CL, Griffin-Korf ML, Aloi JA, et al. Polycystic ovary syndrome: evidence for reduced sensitivity of the gonadotropin-releasing hormone pulse generator to inhibition by estradiol and progesterone. J Clin Endocrinol Metab 1998; 83:582.
  42. Futterweit W, Deligdisch L. Histopathological effects of exogenously administered testosterone in 19 female to male transsexuals. J Clin Endocrinol Metab 1986; 62:16.
  43. Chung JP, Yiu AK, Chung TK, Chan SS. A randomized crossover study of medroxyprogesterone acetate and Diane-35 in adolescent girls with polycystic ovarian syndrome. J Pediatr Adolesc Gynecol 2014; 27:166.
  44. Harel Z, Johnson CC, Gold MA, et al. Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections. Contraception 2010; 81:281.
  45. Bonny AE, Secic M, Cromer BA. A longitudinal comparison of body composition changes in adolescent girls receiving hormonal contraception. J Adolesc Health 2009; 45:423.
  46. Rosenfield RL, Ehrmann DA. The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocr Rev 2016; 37:467.
  47. Azziz R, Black VY, Knochenhauer ES, et al. Ovulation after glucocorticoid suppression of adrenal androgens in the polycystic ovary syndrome is not predicted by the basal dehydroepiandrosterone sulfate level. J Clin Endocrinol Metab 1999; 84:946.
  48. Rosenfield RL. Clinical practice. Hirsutism. N Engl J Med 2005; 353:2578.
  49. Shapiro J. Clinical practice. Hair loss in women. N Engl J Med 2007; 357:1620.
  50. Swiglo BA, Cosma M, Flynn DN, et al. Clinical review: Antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. J Clin Endocrinol Metab 2008; 93:1153.
  51. Ibáñez L, Potau N, Marcos MV, de Zegher F. Treatment of hirsutism, hyperandrogenism, oligomenorrhea, dyslipidemia, and hyperinsulinism in nonobese, adolescent girls: effect of flutamide. J Clin Endocrinol Metab 2000; 85:3251.
  52. Manso G, Thole Z, Salgueiro E, et al. Spontaneous reporting of hepatotoxicity associated with antiandrogens: data from the Spanish pharmacovigilance system. Pharmacoepidemiol Drug Saf 2006; 15:253.
  53. Heinemann LA, Will-Shahab L, van Kesteren P, et al. Safety of cyproterone acetate: report of active surveillance. Pharmacoepidemiol Drug Saf 1997; 6:169.
  54. Domecq JP, Prutsky G, Mullan RJ, et al. Adverse effects of the common treatments for polycystic ovary syndrome: a systematic review and meta-analysis. J Clin Endocrinol Metab 2013; 98:4646.
  55. de Zegher F, Ibáñez L. Therapy: Low-dose flutamide for hirsutism: into the limelight, at last. Nat Rev Endocrinol 2010; 6:421.
  56. Moran LJ, Noakes M, Clifton PM, Norman RJ. The use of anti-mullerian hormone in predicting menstrual response after weight loss in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab 2007; 92:3796.
  57. Freemark M. Management of adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab 2011; 96:3354.
  58. Ladson G, Dodson WC, Sweet SD, et al. The effects of metformin with lifestyle therapy in polycystic ovary syndrome: a randomized double-blind study. Fertil Steril 2011; 95:1059.
  59. Geller DH, Pacaud D, Gordon CM, et al. State of the Art Review: Emerging Therapies: The Use of Insulin Sensitizers in the Treatment of Adolescents with Polycystic Ovary Syndrome (PCOS). Int J Pediatr Endocrinol 2011; 2011:9.
  60. Jamal M, Gunay Y, Capper A, et al. Roux-en-Y gastric bypass ameliorates polycystic ovary syndrome and dramatically improves conception rates: a 9-year analysis. Surg Obes Relat Dis 2012; 8:440.
  61. Rochester D, Jain A, Polotsky AJ, et al. Partial recovery of luteal function after bariatric surgery in obese women. Fertil Steril 2009; 92:1410.
  62. Miller RA, Chu Q, Xie J, et al. Biguanides suppress hepatic glucagon signalling by decreasing production of cyclic AMP. Nature 2013; 494:256.
  63. Pau CT, Keefe C, Duran J, Welt CK. Metformin improves glucose effectiveness, not insulin sensitivity: predicting treatment response in women with polycystic ovary syndrome in an open-label, interventional study. J Clin Endocrinol Metab 2014; 99:1870.
  64. Buse JB, DeFronzo RA, Rosenstock J, et al. The Primary Glucose-Lowering Effect of Metformin Resides in the Gut, Not the Circulation: Results From Short-term Pharmacokinetic and 12-Week Dose-Ranging Studies. Diabetes Care 2016; 39:198.
  65. Ferrannini E. The target of metformin in type 2 diabetes. N Engl J Med 2014; 371:1547.
  66. Pernicova I, Korbonits M. Metformin--mode of action and clinical implications for diabetes and cancer. Nat Rev Endocrinol 2014; 10:143.
  67. Rice S, Elia A, Jawad Z, et al. Metformin inhibits follicle-stimulating hormone (FSH) action in human granulosa cells: relevance to polycystic ovary syndrome. J Clin Endocrinol Metab 2013; 98:E1491.
  68. Kurzthaler D, Hadziomerovic-Pekic D, Wildt L, Seeber BE. Metformin induces a prompt decrease in LH-stimulated testosterone response in women with PCOS independent of its insulin-sensitizing effects. Reprod Biol Endocrinol 2014; 12:98.
  69. Di Pietro M, Parborell F, Irusta G, et al. Metformin regulates ovarian angiogenesis and follicular development in a female polycystic ovary syndrome rat model. Endocrinology 2015; 156:1453.
  70. Orban JC, Fontaine E, Ichai C. Metformin overdose: time to move on. Crit Care 2012; 16:164.
  71. Xiao H, Zhang J, Xu Z, et al. Metformin is a novel suppressor for transforming growth factor (TGF)-β1. Sci Rep 2016; 6:28597.
  72. Bridger T, MacDonald S, Baltzer F, Rodd C. Randomized placebo-controlled trial of metformin for adolescents with polycystic ovary syndrome. Arch Pediatr Adolesc Med 2006; 160:241.
  73. Harborne L, Fleming R, Lyall H, et al. Descriptive review of the evidence for the use of metformin in polycystic ovary syndrome. Lancet 2003; 361:1894.
  74. Lord JM, Flight IH, Norman RJ. Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome. Cochrane Database Syst Rev 2003; :CD003053.
  75. Barbieri RL. Metformin for the treatment of polycystic ovary syndrome. Obstet Gynecol 2003; 101:785.
  76. Díaz M, López-Bermejo A, Sánchez-Infantes D, et al. Responsiveness to metformin in girls with androgen excess: collective influence of genetic polymorphisms. Fertil Steril 2011; 96:208.
  77. Legro RS, Barnhart HX, Schlaff WD, et al. Ovulatory response to treatment of polycystic ovary syndrome is associated with a polymorphism in the STK11 gene. J Clin Endocrinol Metab 2008; 93:792.
  78. Baillargeon JP, Jakubowicz DJ, Iuorno MJ, et al. Effects of metformin and rosiglitazone, alone and in combination, in nonobese women with polycystic ovary syndrome and normal indices of insulin sensitivity. Fertil Steril 2004; 82:893.
  79. Eisenhardt S, Schwarzmann N, Henschel V, et al. Early effects of metformin in women with polycystic ovary syndrome: a prospective randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab 2006; 91:946.
  80. Ibáñez L, Díaz M, Sebastiani G, et al. Oral contraception vs insulin sensitization for 18 months in nonobese adolescents with androgen excess: posttreatment differences in C-reactive protein, intima-media thickness, visceral adiposity, insulin sensitivity, and menstrual regularity. J Clin Endocrinol Metab 2013; 98:E902.
  81. Al Khalifah RA, Florez ID, Dennis B, et al. Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis. Pediatrics 2016; 137.
  82. Bredella MA, McManus S, Misra M. Impact of metformin monotherapy versus metformin with oestrogen-progesterone on lipids in adolescent girls with polycystic ovarian syndrome. Clin Endocrinol (Oxf) 2013; 79:199.
  83. Domecq JP, Prutsky G, Mullan RJ, et al. Lifestyle modification programs in polycystic ovary syndrome: systematic review and meta-analysis. J Clin Endocrinol Metab 2013; 98:4655.
  84. Tang T, Glanville J, Hayden CJ, et al. Combined lifestyle modification and metformin in obese patients with polycystic ovary syndrome. A randomized, placebo-controlled, double-blind multicentre study. Hum Reprod 2006; 21:80.
  85. Fauser BC, Tarlatzis BC, Rebar RW, et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2012; 97:28.
  86. Tang T, Lord JM, Norman RJ, et al. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev 2012; :CD003053.
  87. Hoeger K, Davidson K, Kochman L, et al. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. J Clin Endocrinol Metab 2008; 93:4299.
  88. Ehrmann DA, Cavaghan MK, Imperial J, et al. Effects of metformin on insulin secretion, insulin action, and ovarian steroidogenesis in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1997; 82:524.
  89. Fleming R, Hopkinson ZE, Wallace AM, et al. Ovarian function and metabolic factors in women with oligomenorrhea treated with metformin in a randomized double blind placebo-controlled trial. J Clin Endocrinol Metab 2002; 87:569.
  90. Moghetti P, Castello R, Negri C, et al. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled 6-month trial, followed by open, long-term clinical evaluation. J Clin Endocrinol Metab 2000; 85:139.
  91. Cosma M, Swiglo BA, Flynn DN, et al. Clinical review: Insulin sensitizers for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. J Clin Endocrinol Metab 2008; 93:1135.
  92. Schwartz SL, Wu JF, Berner B. Metformin extended release for the treatment of type 2 diabetes mellitus. Expert Opin Pharmacother 2006; 7:803.
  93. Ibáñez L, López-Bermejo A, Díaz M, et al. Early metformin therapy (age 8-12 years) in girls with precocious pubarche to reduce hirsutism, androgen excess, and oligomenorrhea in adolescence. J Clin Endocrinol Metab 2011; 96:E1262.
  94. Ibáñez L, Valls C, Marcos MV, et al. Insulin sensitization for girls with precocious pubarche and with risk for polycystic ovary syndrome: effects of prepubertal initiation and postpubertal discontinuation of metformin treatment. J Clin Endocrinol Metab 2004; 89:4331.
  95. Crisosto N, Echiburú B, Maliqueo M, et al. Improvement of hyperandrogenism and hyperinsulinemia during pregnancy in women with polycystic ovary syndrome: possible effect in the ovarian follicular mass of their daughters. Fertil Steril 2012; 97:218.
  96. Vanky E, Carlsen SM. Androgens and antimüllerian hormone in mothers with polycystic ovary syndrome and their newborns. Fertil Steril 2012; 97:509.
  97. Yki-Järvinen H. Thiazolidinediones. N Engl J Med 2004; 351:1106.
  98. Jensterle M, Kravos NA, Pfeifer M, et al. A 12-week treatment with the long-acting glucagon-like peptide 1 receptor agonist liraglutide leads to significant weight loss in a subset of obese women with newly diagnosed polycystic ovary syndrome. Hormones (Athens) 2015; 14:81.
  99. Jensterle Sever M, Kocjan T, Pfeifer M, et al. Short-term combined treatment with liraglutide and metformin leads to significant weight loss in obese women with polycystic ovary syndrome and previous poor response to metformin. Eur J Endocrinol 2014; 170:451.
  100. Facchinetti F, Bizzarri M, Benvenga S, et al. Results from the International Consensus Conference on Myo-inositol and d-chiro-inositol in Obstetrics and Gynecology: the link between metabolic syndrome and PCOS. Eur J Obstet Gynecol Reprod Biol 2015; 195:72.
  101. Paul C, Laganà AS, Maniglio P, et al. Inositol's and other nutraceuticals' synergistic actions counteract insulin resistance in polycystic ovarian syndrome and metabolic syndrome: state-of-the-art and future perspectives. Gynecol Endocrinol 2016; 32:431.
  103. Dokras A. Mood and anxiety disorders in women with PCOS. Steroids 2012; 77:338.
  104. Veltman-Verhulst SM, Boivin J, Eijkemans MJ, Fauser BJ. Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Hum Reprod Update 2012; 18:638.
  105. Baba T, Endo T, Ikeda K, et al. Distinctive features of female-to-male transsexualism and prevalence of gender identity disorder in Japan. J Sex Med 2011; 8:1686.
  106. Mueller A, Gooren LJ, Naton-Schötz S, et al. Prevalence of polycystic ovary syndrome and hyperandrogenemia in female-to-male transsexuals. J Clin Endocrinol Metab 2008; 93:1408.
  107. Becerra-Fernández A, Pérez-López G, Román MM, et al. Prevalence of hyperandrogenism and polycystic ovary syndrome in female to male transsexuals. Endocrinol Nutr 2014; 61:351.
  108. Ehrmann DA. Metabolic dysfunction in pcos: Relationship to obstructive sleep apnea. Steroids 2012; 77:290.
  109. de Sousa G, Schlüter B, Buschatz D, et al. A comparison of polysomnographic variables between obese adolescents with polycystic ovarian syndrome and healthy, normal-weight and obese adolescents. Sleep Breath 2010; 14:33.
  110. Nandalike K, Agarwal C, Strauss T, et al. Sleep and cardiometabolic function in obese adolescent girls with polycystic ovary syndrome. Sleep Med 2012; 13:1307.