Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome†‡

Abstract

STUDY QUESTIONWhat is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise and consumer preference?SUMMARY ANSWERInternational evidence-based guidelines, including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS.WHAT IS KNOWN ALREADYPrevious guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial, and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist.STUDY DESIGN, SIZE, DURATIONInternational evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength.PARTICIPANTS/MATERIALS, SETTING, METHODSGovernance included a six continent international advisory and a project board, five guideline development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis and translation experts. In total, 37 societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels.MAIN RESULTS AND THE ROLE OF CHANCEThe evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: (i) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; (ii) reducing unnecessary testing; (iii) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and (iv) emphasizing evidenc...

Comorbidities and complications of polycystic ovary syndrome: An overview of systematic reviews

“…We identified that having PCOS correlates with an increased risk of adverse pregnancy, foetal and neonatal events including preeclampsia, PIH, preterm delivery, caesarean delivery, miscarriage, perinatal death, neonatal hypoglycaemia 18 and GDM 17,18 which is line with the current evidence-based guidelines 6 and specialty society position statements. [55][56][57][58][59] However, these links should be interpreted with caution owing to the limited number of systematic reviews, their diverse quality and significant betweenstudy heterogeneity including study size and different diagnostic criteria.…”

“…Our findings also aligned with recent recommendations from the international evidence-based guidelines in PCOS. 6 We report for the first time a comprehensive summary and quality assessment of systematic reviews assessing comorbidities and complications in women with PCOS. We confirm that PCOS has a range of reproductive, metabolic, psychological and other manifestations.…”

“…We also aimed to explore alignment between the evidence and recent evidence-based guidelines in PCOS adopted across 37 international societies. 6 2 | ME THODS…”

Age‐specific reference ranges of serum anti‐müllerian hormone in healthy women and its application in diagnosis of polycystic ovary syndrome: a population study

“…This is probably one of the reasons that serum AMH levels should not yet be used as an alternative for diagnosing polycystic ovary morphology or PCOS, as recommended in the latest international guideline on PCOS. 35 Adoption of the MoM AMH would overcome this problem. The concept of MoM for diagnostic purposes has been widely adopted in prenatal diagnosis such as Down's screening using various biomedical markers, which adjusts for the change of these parameters with gestational age.…”

Prevalence of polycystic ovary syndrome in women with severe obesity – Effects of a structured weight loss programme

“…6 Clinical hyperandrogenism was defined as the presence of hirsutism measured by a self-reported Ferriman-Gallwey score ≥6. 19 Biochemical hyperandrogenism was defined as previously published 13 by total testosterone >1.2 nmol/L, free testosterone >0.035 nmol/L or a FAI >5. Oligo-or anovulation was estimated in retrospect by oligo-or amenorrhoea where oligomenorrhea was defined as >35 days cycle and or <8 cycles per year, and amenorrhoea as no menstruation for over 3 months.…”