Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, a demographic which includes adolescents as well. Accurate data on the prevalence and incidence in the adolescent population is unavailable. This is largely due to the variable nature of this disorder, uncertain etiology and diagnostic challenges that often lead to the late diagnosis of PCOS, typically during adulthood. The diagnosis of PCOS should be considered in any adolescent female with a main complaint of hirsutism, menstrual irregularity and often followed by obesity. In general these are not rare complaints for adolescent females. There are also long term consequences associated with PCOS, which, in addition to infertility include type 2 diabetes mellitus, metabolic syndrome and possibly cardiovascular disease and endometrial carcinoma.Acanthosis nigricans, treatment-resistant acne, scalp hair loss or hyperhidrosis may alternatively present as the chief complaint, although these features are not always present. Treatment for an adolescent with PCOS is primarily directed at the major clinical manifestations and complaints. Several treatment options have been developed for each of these and some options address more than one symptom. However, the initial measure is to adopt a healthy lifestyle, with a strong focus on reducing the body weight in obese patients, which, in combination with some other therapeutic procedures, leads to an optimal effect of therapy. It also helps reduce the risk of certain cancers and improve the quality of life.Targeting of the etiologic factor is not yet possible, although pathophysiologic explanation for it remains an area of intense study. This review focuses on the pathophysiology, presentation and diagnosis of PCOS in adolescence together with its clinical management.