New guidelines for the management of polycystic ovary syndrome

The guidelines for the evaluation and management of polycystic ovary syndrome follow international best practice recommendations for the diagnosis, evaluation and treatment of this often neglected disease.

In 2023 International evidence-based guidelines for the evaluation and management of polycystic ovary syndrome (PCOS) aims to provide clear information, facilitate shared decision-making, and support optimal patient care and better health outcomes for women affected by PCOS.

The Australian-led initiative enlisted the participation of more than 3,000 health professionals and over 100 clinical and lived experience experts from 71 countries.

in summary Published in Australian Medical JournalProfessor Helena Teed, from Monash University, and colleagues outlined the guidelines' key recommendations.

“Following strong calls from patient and consumer groups, the guidelines address a condition that affects one in eight Australian women and 140 million women worldwide and is complex, underdiagnosed, undertreated, underfunded and researched, misnamed and misunderstood,” Professor Teed and his colleagues wrote.

“The 2023 guidelines have been approved by the National Health and Medical Research Council and provide clinicians and patients with clear advice on best practice in this common but neglected condition, based on the best available evidence, expert multidisciplinary opinion and consumer preferences.”

The recommendations outlined in the guidelines include:

Refinements to diagnostic criteria

The guidelines recommend refining individual diagnostic criteria according to international evidence-based standards.

For adults, at least two of the following criteria must be met:

• clinical or biochemical hyperandrogenism;
• Ovulatory problems or irregular cycles
• Polycystic ovarian appearance or morphology (PCOM) identified by ultrasound or anti-Müllerian hormone levels.

Because there is a risk of underdiagnosis and long-term complications if PCOS is not identified early, the guidelines recommend identifying and following up adolescents who meet only one criterion.

“Timely diagnosis, prior to long-term use of contraceptives, which may mask symptoms of PCOS, could identify and prevent individuals at high risk of long-term complications,” Professor Teed and colleagues wrote.

Recognizing the Broad Features of PCOS

A range of complications associated with PCOS is now recognised, including metabolic effects, cardiovascular disease, skin symptoms, sleep apnea, a high prevalence of psychological features and a high risk of adverse pregnancy outcomes.

“Patients with PCOS are encouraged to be aware that they may have increased cardiovascular disease risk factors, cardiovascular disease, and cardiovascular disease mortality,” Professor Teed and colleagues wrote.

“Potential increased cardiometabolic risks in first-degree family members, including diabetes, metabolic syndrome, and hypertension, were also recognized.”

Improving models of care

The guidelines emphasize the need for high-quality information for patients, increased specialty education for clinicians, and an emphasis on shared decision-making and patient-centered care.

“Providing comprehensive and accurate information is paramount to enable shared, informed decision-making and enhance knowledge and self-management,” the authors write.

“Health professionals have a vital role to play in communicating openly and respectfully and providing guidance and support in individualized, person-centred care.”

Physical and Mental Health

The guidelines recognise and take into account weight stigma whilst emphasising healthy lifestyles, mental health and quality of life.

“Lifestyle management is recommended for all people with PCOS and should include both prevention of weight gain and support for those who are overweight or obese,” Prof Teed and colleagues wrote.

“Healthy lifestyle behaviors, including a healthy diet and physical activity, should be encouraged to optimize general health and metabolism and improve quality of life, and it should be noted that benefits are available even in the absence of weight loss.”

The guidelines also recommend screening for depression, anxiety and possibly eating disorders.

“All health professionals should be aware that PCOS increases the risk of negative psychosocial outcomes and psychiatric disorders, including depression, anxiety, eating disorders, disordered eating, body image concerns, low self-esteem, and feminine identity issues,” the authors write.

Fertility

Although PCOS is associated with poor pregnancy outcomes, patients should be confident that they will have a successful pregnancy, especially if PCOS is diagnosed early.

The guidelines recommend evidence-based medical therapies and fertility treatments, including the use of oral ovulation induction drugs, prenatal vitamin supplementation, and optimization of lifestyle factors such as weight, exercise, smoking, and blood pressure.

Low-dose gonadotropins and laparoscopic ovarian surgery are recommended as second-line treatment options.

Please read Overview of the Guidelines Australian Medical Journal.

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