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Background: The PCOS Clinic is led by a multidisciplinary team that provides specialized treatment to adolescents with PCOS, a condition characterized by menstrual irregularity and hyperandrogenism. Common medications prescribed are insulin sensitizer metformin and oral contraceptives to improve hyperandrogenism and regulate menses. Anecdotally, patients were not taking the prescribed treatment when evaluated for follow up. The goal of this preliminary study was to investigate medication non-adherence and evaluate demographic and health differences between prescription adherent and non-adherent patients.

Methods: A secondary data analysis (n=50) was conducted on patients diagnosed with PCOS ages 13-18 years between August 1, 2015-December 31, 2020. Six patients were omitted due to no information on medication adherence (n=44). All subjects presented with signs of biochemical/clinical hyperandrogenism and irregular menses. Patients were divided into adherent and non-adherent groups based on medical record documentation. Race, ethnicity, medical history (psychiatric disorders, ADHD, and gastrointestinal issues), and insurance coverage were factors compared.

Results: 18 of 44 girls (41%) failed to comply with their prescribed metformin and/or oral contraceptive regimens at first follow up. The majority of patients evaluated were Caucasian (35/44, 70%). Caucasians were more likely to be adherent (63%) compared to non-adherent (37%). Out of the Caucasians who were adherent, 68% were non-Hispanic and 32% were Hispanic. All of the non-Caucasian, non-adherent patients were African American. Of the entire non-adherent group, 39% had a history of anxiety, depression, or ADHD, in contrast to 31% of the adherent group. We did not see an effect of insurance type or history of gastrointestinal issues (GI) on adherence. The most common reasons for non-adherence were GI side effects (44%), prescriptions not refilled (17%), belief that medications did not help (17%), and parent hesitation about daughters being on medications (17%). All patients with GI side effects were taking metformin and none had baseline GI concerns. Of the patients with GI side effects, 63% had a diagnosis of anxiety/depression. None of the other non-adherent groups included patients with psychiatric disorders.

Conclusion: Medication adherence is a barrier to treatment of adolescents with PCOS. Lack of treatment can contribute to menstruation irregularities and metabolic consequences. This increases risk for comorbidities including endometrial cancer, metabolic syndrome, and diabetes. Interventions to improve patient adherence like increased medication counseling regarding management of side effects is one possible intervention. More data is needed to explore the relationship of race and adherence with tailored interventions to remove barriers to care.

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A Descriptive Examination Of Medication Adherence In Adolescent Patients With Polycystic Ovary Syndrome (PCOS)