New International Practice Guideline Released for Polycystic Ovary Syndrome

A 2023 International Evidence-Based Guideline update, which appeared in the European Journal of Endocrinology, expanded upon the 2018 guidelines for assessing and managing polycystic ovary syndrome (PCOS).

According to the guideline authors, the objective of the guideline is to improve the quality of life of individuals with PCOS globally by providing comprehensive, high-quality, evidence-based guidelines for diagnosis, assessment, and treatment.

The guideline committee presented guideline recommendations by category, terms used, evidence quality, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework considerations. Evidence quality was categorized according to the GRADE framework and included high, moderate, low, and very low certainty of evidence.

The guideline contains many recommendations, including 77 that are evidence-based, 54 that are based on consensus, and 123 practice points.

Key updates have been made to the diagnostic criteria for PCOS in the 2023 update and include that PCOS should be diagnosed using the 2018 International Evidence-Based Guideline criteria. Other updates include further refinement of individual diagnostic criteria, simplification of the diagnostic algorithm, and including anti-Müllerian hormone (AMH) levels as an alternative to ultrasound in adults only. AMH appeared in the 2018 guidelines as a rapidly evolving area, but the evidence is strong enough to include it in the recommendations in the 2023 update. The updates also emphasize the broader features of PCOS, including metabolic risk factors, cardiovascular disease, sleep apnea, a high prevalence of psychologic features, and increased risk for adverse outcomes during pregnancy. The updates highlight the diverse burden of the disease and the need for greater health care professional education, evidence-based patient information, improved models of care, and shared decision-making to improve patient outcomes.

In the 2023 update, the recommendations have been strengthened and the evidence has improved, but the overall quality is still low to moderate. There is a critical need for more extensive research in PCOS, which is a neglected but prevalent condition. Regional differences in health systems have been taken into account and recognized, with a subsequent procedure for adapting guidelines and translation resources.

“With effective translation, the guideline will address priorities identified by women with PCOS, upskill health care professionals, empower consumers, improve care and outcomes, identify key research gaps, and promote vital future research,” wrote the guideline committee.