When a girl reaches puberty, her body undergoes huge changes due to the secretion of sex hormones, such as breast development, weight gain, pubic hair, menstruation, and the tendency to develop “acne”. However, gynecologists point out that if a girl has these symptoms, especially if her periods are still abnormal after two years, she should consider polycystic ovary syndrome (PCOS for short). In the 2013 cross-strait symposium on polycystic ovary syndrome, gynecologists emphasized that the physiological changes of pubertal development are very similar to the clinical symptoms of polycystic ovary syndrome, and many parents and girls mistakenly think that it is a “normal phenomenon” of growth and development, thus ignoring the real disease and delaying the treatment time. In recent years, gynecologists have encountered more and more adolescent girls suffering from polycystic ovary syndrome in the clinic, who often come to the doctor because of irregular menstruation, such as scanty periods or even amenorrhea. In fact, they have been experiencing various “symptoms” before that, but these symptoms are so similar to the physical changes they experience during puberty that they never think they are suffering from polycystic ovary syndrome until their irregular periods last for too long before they come to the doctor. If, during puberty, a girl develops the following three major symptoms, she should pay enough attention to them. Feature 1: Obesity and acanthosis nigricans Girls begin to enter puberty at the age of 10-12. With the rapid growth of the ovaries, estrogen levels continue to rise, breasts, external genitalia, pubic hair, etc. gradually develop, and finally the first menstruation occurs. All these changes are signs that girls are “growing up and maturing” and parents and girls themselves are used to them. However, the polycystic ovary syndrome (because of abnormal lipid metabolism) that starts in adolescence is often accompanied by obesity, and this obesity starts at the age of 4 or 5, and gradually increases in adolescence, and by the time of menstruation, the weight will increase rapidly, thus often growing into a “tiger’s back and waist” condition. Next, there is acanthosis nigricans, a velvety, warty, hyperpigmented skin that appears on these girls, especially on the neck, armpits, under the breasts, and in the vulva, groin and other body folds. This is actually a “special sign” on the skin caused by insulin resistance. Characteristics 2: Hirsutism and acne Due to polycystic ovary syndrome, the body is overloaded with androgens, and this hyperandrogenism manifests itself as hirsutism, acne, or masculinity. Hirsutism occurs in about 60-70% of patients. Hirsutism refers to an increase in “sexual hair”, such as thick, long, dark, stiff hairs on the upper lip or under the chin, around the areola, and in the midline of the lower and middle abdomen. This kind of hirsutism is different from excessive hair on the body surface. At the same time, there is also an increase in the secretion of androgens, which stimulates the sebaceous glands to hypertrophy and increase sebum production. This acne is found on the face, forehead, cheekbones, around the nose, and even on the neck and chest and back. In mild cases, the acne may appear as small pimples, while in severe cases, the skin may become pitted. It is worth noting that acne in patients with polycystic ovary syndrome is different from general adolescent acne. The former is often accompanied by rough skin and enlarged pores, and is characterized by heavy symptoms, long duration, stubbornness, and poor treatment results. Feature 3: Sparse menstruation and irregular menstruation The menstrual pattern of polycystic ovary syndrome in adolescence is mainly characterized by sparse menstruation (menstrual cycle of 35 days to 6 months), secondary amenorrhea (menopause of ≥ 6 months) or primary amenorrhea (no first menstruation at the age of 16), and irregular uterine bleeding (irregular menstrual cycle or period or volume of menstruation). Adolescents with polycystic ovary syndrome usually have normal age at menarche, but most patients have irregular periods from menarche onwards. Some present with amenorrhea (≥6 months of menopause), scanty menstruation (35 days to 6 months of menstrual cycle), irregular and non-ovulatory cycles of menstruation, or they can present with severe menstrual disorders. Studies have shown that about 45%-57% of girls with scanty menstruation during puberty who also have symptoms such as hirsutism, obesity, acne, and also high androgens are in the category of polycystic ovary syndrome. Obesity, hirsutism, and irregular menstruation should be screened for polycystic ovary syndrome in adolescent high-risk groups (e.g., obesity, hirsutism, irregular menstruation). Unlike adult women, experts recommend that when diagnosing polycystic ovary syndrome in adolescence, patients should meet 3 indicators at the same time: 1. i.e. menstrual sparseness or amenorrhea still present 2 years after menarche; 2. polycystic ovarian changes under ultrasound; 3. hyperandrogenemia. Many adolescent women experience irregular menstruation after menarche. About 85% of women have anovulatory menstruation in the first year of menarche, but the vast majority develop regular ovulation 2 years after menarche. Persistently anovulatory women may be at high risk for developing adolescent PCOS. Since polycystic ovary syndrome is a lifelong disease that develops during adolescence, it is highlighted by obesity, hirsutism, acne, and menstrual disorders. And in adulthood, they often suffer from infertility due to non-ovulation. So how should polycystic ovary syndrome be treated in adolescents? , once the diagnosis of polycystic ovary syndrome in adolescence is established, the main goal of treatment is to correct menstrual disorders and control hirsutism, which can be done with oral contraceptives, here not for contraceptive purposes but for therapeutic purposes, such as achieving anti-androgenism. On the other hand is lifestyle modification. For example, weight control, increased exercise and appropriate dieting, and if abnormal glucose tolerance is found, then treatment of prediabetes should also be considered. Finally, since patients with polycystic ovary syndrome cannot be cured, they also need regular review and adjustment of different treatment plans according to their condition.