Introduction
Aetiology: insulin resistance and hyperandrogenism
Impact of obesity on polycystic ovary syndrome
Diagnosis of PCOS
National Institutes of Health criteria consensus statement [83] | European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine consensus statement [20] | Androgen Excess Society position statement [21] |
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Oligo-ovulation and clinical and/or biochemical signs of hyperandrogenism, and exclusion of other aetiologies* | Two out of three of: oligo-ovulation and/or anovulation, clinical and/or biochemical signs of hyperandrogenism, or polycystic ovaries, and exclusion of other aetiologies* | Hyperandrogenism (hirsutism and/or hyperandrogeniaemia), ovarian dysfunction (oligoanovulation and/or polycystic ovaries), and exclusion of other androgen excess related disorders* |
Clinical features of PCOS
Reproductive features of PCOS
Ovarian dysfunction and infertility
Hyperandrogenism
Metabolic features of PCOS
Dyslipidaemia
Insulin resistance and abnormal glucose metabolism
Cardiovascular disease risk
Psychological features of PCOS
Investigations and assessment in PCOS
Treatment of PCOS
Targeted approach to therapy
Resource | Description |
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Evidence-based independent consumer and health professional information | |
Evidence-based independent consumer and health professional information | |
PCOS patient fact sheets | Freely available: link from website above |
Weight loss, exercise and lifestyle interventions
Pharmacological therapy in PCOS
Conclusions
Appendix 1
Reproductive, metabolic and psychosocial features of polycystic ovary syndrome (PCOS)
Clinical features of PCOS
Appendix 2
Summary of treatment options in polycystic ovary syndrome (PCOS)
Oligomenorrhoea/amenorrhoea
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Lifestyle change (5% to 10% weight loss and structured exercise).
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Oral contraceptive pill (OCP; low oestrogen doses, for example 20 μg may be preferable).
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Cyclic progestins (for example, 10 mg medroxyprogesterone acetate for 14 days every 2 to 3 months).
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Metformin (improves ovulation and menstrual cyclicity).
Hirsutism treatment recommendations
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Cosmetic therapy.
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Laser treatment.
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Eflornithine cream can be added and may induce a more rapid response.
Pharmacological therapy
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Medical therapy if patient concerned about hirsutism and cosmetic therapy ineffective, inaccessible or unaffordable.
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Primary therapy is the OCP (monitor glucose tolerance in those at risk of diabetes).
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Antiandrogen monotherapy should not be used without adequate contraception.
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Trial therapies for ≥ 6 months before changing dose or medication.
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Combination therapy: if ≥ 6 months of OCP is ineffective, add antiandrogen to OCP (daily spironolactone 50 mg twice a day or cyproterone acetate 25 mg/day for days 1 to 10 of the active OCP tablets).
Infertility
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Obesity independently exacerbates infertility and reduces effectiveness of interventions. Maternal and foetal pregnancy risks are greater and long-term metabolic outcomes in the child are related to maternal weight at conception. Consistent with international guidelines, women who are overweight prior to conception should be advised on folate, smoking cessation, weight loss and optimal exercise, prior to additional interventions.
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Given age-related infertility, advise women to optimise family planning.
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Infertility therapies may include clomiphene, gonadotrophins and in vitro fertilisation.