Lifestyle interventions are the first-line treatment for most adolescents with PCOS [7]. These interventions should ideally be multi-component, including dietary changes, less sedentary behaviour, exercise, and behavioural strategies. They should be recommended to all adolescents with PCOS and excess weight to achieve reductions in weight, central adiposity, insulin resistance [5], type 2 diabetes [8], dyslipidaemia, hypertension, and metabolic syndrome [1]. Education and counselling about lifestyle modifications should include families and consider family dynamics. Family readiness to change can influence adolescents’ motivation and ability to alter their behaviours [8].

Based on lifestyle interventions (including diet, reduced sedentary behaviour, exercise, and behavioural strategies), pharmacological interventions should be considered for adolescents with a clear diagnosis of PCOS or “at risk” of PCOS. Pharmacological treatments include the use of combined oral contraceptive pills (COCPs) and/or metformin for the management of symptoms [5]. Where COCPs are contraindicated, poorly tolerated, or ineffective, antiandrogens could be considered to treat hirsutism [5]. Effective contraception should be used in combination with antiandrogens, due to the teratogenic potential of antiandrogens and the risk of impairing external genital development in male foetuses [5]. Physiologic hyperinsulinaemia and insulin resistance in adolescents should be carefully evaluated before the use of metformin to avoid overtreatment. Medical therapy is generally not specifically approved for use in women with PCOS, so its use is often evidence-based but off-label [4]. Although off-label use is predominantly evidence-based and permitted in many countries [5], healthcare professionals must inform adults, adolescents, their parents, or guardians, and discuss the evidence, possible concerns, and side effects of the treatment [4]. Regulatory agencies should consider the approval of evidence-based medications for use in adolescent PCOS [4].