International PCOS Network Issues New Guidelines for Management and Diagnosis of PCOS

A new International Guideline for the Assessment and Management of polycystic ovary syndrome (PCOS) has been issued by the International PCOS Network to help clinicians optimize evidence-based consistent care that meets the needs as well as improves the quality of life for people with PCOS. These guidelines were published in Human Reproduction.

The new guideline includes 31 evidence-based recommendations, 59 clinical consensus recommendations, and 76 clinical practice points. Key recommendations include:

• When irregular menstrual cycles are present, PCOS should be considered and evaluated according to the guidelines.
• Calculated free testosterone, free androgen index, or calculated bioavailable testosterone should be used to assess biochemical hyperandrogenism in the diagnostic workup.
• Diagnosis should include a comprehensive history and physical examination; common symptoms and signs of clinical hyperandrogenism include acne, alopecia, and hirsutism, which can be severe in adolescents.
• Clinicians should consider ethnic variation in the presentation and manifestations of PCOS.
• Both clinicians and patients should be aware that there is a 2- to 6-fold increased risk for endometrial cancer, but the absolute risk for the disease remains relatively low.
• Ultrasound should not be used to make a diagnosis in those with a gynecologic age of <8 years (<8 years after menarche) because of the high incidence of multifollicular ovaries at this time.
• Serum anti-Müllerian hormone should not yet be used as an alternative for the detection of PCO morphology or as a single diagnostic test.
• Preventing weight gain, monitoring weight, and encouraging evidence-based and socioculturally appropriate healthy lifestyle is important in PCOS, particularly from adolescence.
• Combined oral contraceptive pills alone are recommended in adult women with PCOS to manage hyperandrogenism and/or irregular menstrual cycles.
• Metformin should be considered in combination with oral contraceptive for management of metabolic features when oral contraceptives and lifestyle changes do not achieve desired goals.

“The combined effects of the provision of a single source of evidence-based recommendations and a comprehensive international translation and dissemination program will amplify the impact of the guideline and recommendations globally,” wrote the authors.

Reference

Teede HJ, Misso ML, Costello MF, et al.; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome [published online July 19, 2018]. Hum Reprod. doi: 10.1093/humrep/dey256