The interdisciplinary S2k guideline on polycystic ovarian syndrome (PCOS) includes a chapter on the medical care of adolescents. Differences in the diagnosis and treatment of PCOS in adolescents compared to adult women are defined. The diagnostic criteria are narrower in adolescents, as pubertal development overlaps with the symptoms of PCOS. Two criteria must be met: hyperandrogenemia or clinical signs of elevated androgen levels, as well as menstrual irregularities. Adolescents who exhibit only one of these symptoms and have additional risk factors, such as being overweight, are classified as “PCOS at risk” patients. Sonographic findings or serum markers of ovarian reserve are not considered. Optimization of diet and exercise, as well as drug therapy, must be adapted to the young age of the patient. It is important to consider the long-term effects of the syndrome, which carries a high risk of overweight, obesity, insulin resistance, and early onset of metabolic syndrome, cardiovascular disease, and endometrial cancer. Depression and anxiety disorders are also more common in young patients.