International guideline produced for polycystic ovary syndrome

An Australian-led international and multidisciplinary collaboration of health professionals and consumers has resulted in the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS).

PCOS is one of the most common hormonal conditions in women, affecting 8–13% of reproductive age women and around 21% of Indigenous women. It often presents in adolescence, with further manifestation in later reproductive life — yet many women are not diagnosed or have long delays before the condition is recognised.

Led by Professor Helena Teede, Director of the Centre for Research Excellence in Polycystic Ovary Syndrome, the collaborators took two years to write the guideline, which includes an integrated translation program incorporating resources for health professionals and consumers. A supplement of the guideline has been published in The Medical Journal of Australia (The MJA), a publication of the Australian Medical Association.

“Obtaining a timely PCOS diagnosis is challenging for women, with many experiencing significant delays with multiple different doctors involved,” the collaborators wrote.

“Inadequate information provision and lack of satisfaction with care has been reported, especially in areas such as psychological features, lifestyle and prevention. Doctors often focus on individual features of PCOS such as infertility, rather than taking a broader approach to care.

“There is also potential for overdiagnosis, including when isolated polycystic ovarian morphology on ultrasound is incorrectly equated with PCOS. This team’s research has clearly shown that access to timely, accurate diagnosis and information provision needs significant improvement.”

The guideline’s main recommendations cover diagnosis, screening and risk assessment depending on life stage; emotional wellbeing; healthy lifestyle; pharmacological treatment for non-fertility indications; and assessment and treatment of infertility. The guideline and associated resources recommend the following changes in management:

Diagnosis

• When the combination of hyperandrogenism and ovulatory dysfunction is present, ultrasound examination of the ovaries is not necessary for diagnosis of PCOS in adult women.
• Diagnosis requires the combination of hyperandrogenism and ovulatory dysfunction in young women within eight years of menarche, with ultrasound examination of the ovaries not recommended, owing to the overlap with normal ovarian physiology.
• Adolescents with some clinical features of PCOS, but without a clear diagnosis, should be regarded as ‘at risk’ and receive follow-up assessment.
   

Screening for metabolic complications

• This has been refined and incorporates both PCOS status and additional metabolic risk factors.
   

Treatment of infertility

• Letrozole is now first-line treatment for infertility as it improves live birth rates while reducing multiple pregnancies compared with clomiphene citrate.
   

“The PCOS guideline and translation resources aim to accelerate the delivery of consistent, evidence-based care across Australia,” the researchers concluded. “GPs are well supported in the implementation of the recommendations from the PCOS guideline by the provision of the range of freely available practice tools, tailored to the Australian context. GPs can also augment the PCOS-related health literacy of consumers by directing them to the range of consumer resources.”

The full guideline and resources, for guideline translation and clinical benefit, can be found at www.pcos-cre.edu.au/evidence-based-guideline/.

Image credit: ©stock.adobe.com/au/reineg