Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

Abstract

Objective:The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS).Participants:An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline.Evidence:This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.Consensus Process:One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematic reviews were conducted to summarize supporting evidence.Conclusions:We suggest using the Rotterdam criteria for diagnosing PCOS (presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries). Establishing a diagnosis of PCOS is problematic in adolescents and menopausal women. Hyperandrogenism is central to the presentation in adolescents, whereas there is no consistent phenotype in postmenopausal women. Evaluation of women with PCOS should exclude alternate androgen-excess disorders and risk factors for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease. Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS. Clomiphene is currently the first-line therapy for infertility; metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities, but it has limited or no benefit in treating hirsutism, acne, or infertility. Hormonal contraceptives and metformin are the treatment options in adolescents with PCOS. The role of weight loss in improving PCOS status per se is uncertain, but lifestyle intervention is beneficial in overweight/obese patients for other health benefits. Thiazolidinediones have an unfavorable risk-benefit ratio overall, and statins require further study.

Overexpression of a DENND1A isoform produces a polycystic ovary syndrome theca phenotype

“…PCOS and normal ovarian tissue came from age-matched women, 38-40 y old. The diagnosis of PCOS was made according to National Institutes of Health (NIH) consensus guidelines (10,49), which include hyperandrogenemia, oligoovulation, polycystic ovaries, and the exclusion of 21-hydroxylase deficiency, Cushing's syndrome, and hyperprolactinemia. All of the PCOS theca cell preparations studied came from ovaries of women with fewer than six menses per year and elevated serum total testosterone or bioavailable testosterone levels (15,17,48).…”

Metformin therapy for the reproductive and metabolic consequences of polycystic ovary syndrome

“…Yet, as aforementioned, whether metformin is of benefit in treating PCOS remains unclear [37,38]. The majority of therapeutic studies have been small in size and have used metformin for a relatively brief period of time [33].…”

“…Therefore, metformin is not recommended as a first-line treatment for management of menstrual irregularity or clinical hyperandrogenism in PCOS because of the lack of evidence for consistent benefits [37,38,44].…”

“…Similarly, in a more recent review consisting of 4227 women with PCOS, metformin only resulted in a marginal improvement in live birth rate when compared with placebo [45]. Therefore, metformin appears to have a limited role in improving fertility and live birth rate in women with PCOS and it is not recommended as a primary treatment for anovulatory infertility in this population [37,38].…”

“…Glucose tolerance Current guidelines for management of PCOS recommend metformin treatment for women with impaired glucose tolerance or type 2 diabetes who do not respond to lifestyle modification [37]. In type 2 diabetes, metformin is the recommended initial therapy and has also been demonstrated to reduce the risk of type 2 diabetes development in individuals with glucose intolerance [51].…”