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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.

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  • Authors+Show Affiliations

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    8401 Connecticut Avenue, Suite 900, Chevy Chase, Maryland 20815. govt-prof@endocrine.org.

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    Source

    MeSH

    Adolescent
    Adult
    Age Factors
    Evidence-Based Medicine
    Female
    Humans
    Middle Aged
    Polycystic Ovary Syndrome
    Societies, Scientific

    Pub Type(s)

    Journal Article
    Practice Guideline

    Language

    eng

    PubMed ID

    24151290

    Citation

    Legro, Richard S., et al. "Diagnosis and Treatment of Polycystic Ovary Syndrome: an Endocrine Society Clinical Practice Guideline." The Journal of Clinical Endocrinology and Metabolism, vol. 98, no. 12, 2013, pp. 4565-92.
    Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4565-92.
    Legro, R. S., Arslanian, S. A., Ehrmann, D. A., Hoeger, K. M., Murad, M. H., Pasquali, R., & Welt, C. K. (2013). Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 98(12), pp. 4565-92. doi:10.1210/jc.2013-2350.
    Legro RS, et al. Diagnosis and Treatment of Polycystic Ovary Syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2013;98(12):4565-92. PubMed PMID: 24151290.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. AU - Legro,Richard S, AU - Arslanian,Silva A, AU - Ehrmann,David A, AU - Hoeger,Kathleen M, AU - Murad,M Hassan, AU - Pasquali,Renato, AU - Welt,Corrine K, AU - ,, Y1 - 2013/10/22/ PY - 2013/10/24/entrez PY - 2013/10/24/pubmed PY - 2014/4/15/medline SP - 4565 EP - 92 JF - The Journal of clinical endocrinology and metabolism JO - J. Clin. Endocrinol. Metab. VL - 98 IS - 12 N2 - 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. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/24151290/full_citation L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2013-2350 DB - PRIME DP - Unbound Medicine ER -