A new evidence‐based guideline for assessment and management of polycystic ovary syndrome

Introduction: We have developed the first international evidence‐based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS), with an integrated translation program incorporating resources for health professionals and consumers. The development process involved an extensive Australian‐led international and multidisciplinary collaboration of health professionals and consumers over 2 years. The guideline is approved by the National Health and Medical Research Council and aims to support both health professionals and women with PCOS in improving care, health outcomes and quality of life. A robust evaluation process will enable practice benchmarking and feedback to further inform evidence‐based practice. We propose that this methodology could be used in developing and implementing guidelines for other women's health conditions and beyond. Main recommendations: The recommendations cover the following broad areas: 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. Changes in management as a result of this guideline: •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;▪requires the combination of hyperandrogenism and ovulatory dysfunction in young women within 8 years of menarche, with ultrasound examination of the ovaries not recommended, owing to the overlap with normal ovarian physiology; and▪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 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.

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“…A summary of the recommendations is published elsewhere 20 . ‐ 22 The MJA has also published an editorial accompanying this supplement 23 …”

Section: Guideline Development Process and Methodsmentioning

confidence: 99%

Translation and implementation of the Australian‐led PCOS guideline: clinical summary and translation resources from the International Evidence‐based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

Teede

Misso

Boyle

et al. 2018

Medical Journal of Australia

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“…oligo-amenorrhoea) and associated hormonal disturbances (eg. hyperandrogenism) (6). Based on several RCTs, the efficacy of such treatment is even comparable to placebo in improving the hormonal disturbances, including total testosterone and free androgen index (6).…”

Section: Current Treatment Guidelinesmentioning

confidence: 99%

The efficacy of using acupuncture in managing polycystic ovarian syndrome

Chen

Lim

2019

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Polycystic ovarian syndrome (PCOS) is a common reproductive disorder, which significantly impairs the fertility of 3-10% of women at reproductive age. It is getting very popular for women with PCOS to seek alternative therapies to treat PCOS, e.g. acupuncture. This review examines the currently available evidence from the randomised controlled trial to guide future recommendation on using acupuncture to assist the treatment of PCOS. Recent findings PCOS is manifested by oligo-amenorrhoea, infertility, and hirsutism. The standard treatment of PCOS includes oral pharmacological agents, lifestyle changes, and surgical modalities. Pharmacologically based therapies are only effective in 60% of the patients, which are also associated with different side effects. As such, acupuncture offered an alternative option. Acupuncture can affect beta-endorphin production, which may, in turn, affect gonadotropin-releasing hormone secretion and affecting ovulation and menstrual cycle. Therefore, it is postulated that acupuncture may induce ovulation and restore menstrual cycle via increasing beta-endorphin production. Summary Although modern medical science has discovered the action mechanisms underlying how acupuncture may manage the symptoms of PCOS, majority of the trials are small in sample size and lack of consistency in the choice of acupoints. Larger scale trials are needed to provide standardised protocols.

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“…Polycystic ovary syndrome (PCOS) is a complex metabolic disorder and the most common endocrine disorder in reproductive-age women that affects between 5-20% of this age group (28). The clinical expression of PCOS varies but commonly includes oligo-ovulation or anovulation, hyperandrogenism (either clinical or biochemical), and the presence of polycystic ovaries (29).…”

Section: Polycystic Ovary Syndromementioning

confidence: 99%

Metformin: A stroke of luck

Aljofan

Gaipov

2019

Electron J Gen Med

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Metformin is an oral glucose-lowering drug that has been widely used for more than half a century. Both the American Diabetes Association and the European Association for the study of Diabetes recommend metformin as the first line therapy for the treatment of type II diabetes mellitus. Metformin has considerably evolved from being an antidiabetic into a drug with a wider potential of therapeutic uses such as anticancer, antiaging, treatment of gestational hypertension, preeclampsia and weight loss. In addition to the in-label use of metformin as an anti-hyperglycemic medication, it is widely prescribed as an off label therapy for young women with Poly Cystic Ovary Syndrome for the treatment of symptoms associated with the disorder. This article is a brief summary that lists and briefly discusses current and potential non-hyperglycemic uses and effects of metformin.

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A new evidence‐based guideline for assessment and management of polycystic ovary syndrome

Cited by 30 publications

References 14 publications

Translation and implementation of the Australian‐led PCOS guideline: clinical summary and translation resources from the International Evidence‐based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

Translation and implementation of the Australian‐led PCOS guideline: clinical summary and translation resources from the International Evidence‐based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

The efficacy of using acupuncture in managing polycystic ovarian syndrome

Metformin: A stroke of luck

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