PCOS New Diagnosis and Treatment Guidelines!

An Endocrine Society task force has developed new guidelines for the treatment of polycystic ovary syndrome (PCOS).

The guidelines published online October 24 in the Journal of Clinical Endocrinology & Metabolism, are aimed at helping physicians and patients understand a complex condition that often has diverse symptoms.

"The Society's recommendations allow physicians to make the diagnosis [of PCOS] if clear symptoms are present without resorting to universal hormone tests or ultrasound screenings," Dr. Legro said in a press release.

The guidelines advise that an adult woman be diagnosed with PCOS if she has at least 2 of the following symptoms:

• excess androgen
• ovulatory dysfunction
• polycystic ovaries

Physicians should Rule Out Other Androgen Excess Disorders and screen patients for:

• endometrial cancer
• mood disorders
• obstructive sleep apnea
• diabetes
• cardiovascular disease

Diagnosis of PCOS in adolescent girls should be based on clinical or biochemical signs of hyperandrogenism, after excluding other possible causes, in the presence of persistent oligomenorrhea, the task force advises. A PCOS diagnosis during perimenopause and menopause should be based on a documented, long-term history of oligomenorrhea and hyperandrogenism in reproductive years, the report advises. A finding of PCO morphology via ultrasound would also provide supportive evidence, although the authors note this is least likely in menopausal women. The guidelines recommend against routine ultrasound for endometrial thickness in women with PCOS.

In diagnosing and treating women with PCOS, physicians should look for:

• terminal hair growth
• acne
• alopecia
• acanthosis nigricans
• skin tags 

* The guidelines also recommend screening for ovulatory status using menstrual history.

The guidelines advise assessment also of: 

• body mass index
• waist circumference
• blood pressure
• oral glucose tolerance

 *Overweight and obese patients with PCOS symptoms should be screened for obstructive sleep apnea. Adults and adolescents should be screened and treated for depression and anxiety.

The committee recommended treatments: 

•  hormonal contraceptives as the first-line therapy for menstrual abnormalities and hirsutism/acne. 
• Exercise therapy is recommended to manage weight, alone or with a calorie-restricted diet.

**The task force advises against the use of metformin as a first-line PCOS treatment, but metformin is recommended for women with PCOS and type 2 diabetes or impaired glucose tolerance who do not succeed with weight loss and exercise. Metformin is also recommended for women who cannot take hormonal contraceptives.

For infertility:

• the report recommends clomiphene citrate as a first-line treatment. 
• For women undergoing in vitro fertilization, the guidelines recommend metformin as adjuvant therapy to prevent ovarian hyperstimulation.

J Clin Endocrinol Metab. Published online October 24, 2013 When Guidelines were produced.