Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline
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 devel...
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| Published in | The journal of clinical endocrinology and metabolism Vol. 98; no. 12; pp. 4565 - 4592 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Bethesda, MD
Oxford University Press
01.12.2013
Copyright by The Endocrine Society Endocrine Society |
| Series | Clinical Practice Guideline |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-972X 1945-7197 1945-7197 |
| DOI | 10.1210/jc.2013-2350 |
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| 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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| AbstractList | 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. The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS). An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline. 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. 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. 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. 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 criteriaandrogen 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. The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS).OBJECTIVEThe aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS).An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline.PARTICIPANTSAn Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline.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.EVIDENCEThis 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.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.CONSENSUS PROCESSOne 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.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.CONCLUSIONSWe 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. |
| Author | Legro, Richard S. Welt, Corrine K. Hoeger, Kathleen M. Arslanian, Silva A. Ehrmann, David A. Murad, M. Hassan Pasquali, Renato |
| AuthorAffiliation | The Penn State University College of Medicine (R.S.L.), Hershey, Pennsylvania 17033; Childrenʼs Hospital of Pittsburgh (S.A.A.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15224; University of Chicago (D.A.E.), Chicago, Illinois 60637; University of Rochester Medical Center (K.M.H.), Rochester, New York 14627; Mayo Clinic (M.H.M.), Rochester, Minnesota 55905; Orsola-Malpighi Hospital, University Alma Mater Studiorum, (R.P.), 40126 Bologna, Italy; and Massachusetts General Hospital (C.K.W.), Boston, Massachusetts 02114 |
| AuthorAffiliation_xml | – name: The Penn State University College of Medicine (R.S.L.), Hershey, Pennsylvania 17033; Childrenʼs Hospital of Pittsburgh (S.A.A.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15224; University of Chicago (D.A.E.), Chicago, Illinois 60637; University of Rochester Medical Center (K.M.H.), Rochester, New York 14627; Mayo Clinic (M.H.M.), Rochester, Minnesota 55905; Orsola-Malpighi Hospital, University Alma Mater Studiorum, (R.P.), 40126 Bologna, Italy; and Massachusetts General Hospital (C.K.W.), Boston, Massachusetts 02114 |
| Author_xml | – sequence: 1 givenname: Richard S. surname: Legro fullname: Legro, Richard S. organization: 1The Penn State University College of Medicine (R.S.L.), Hershey, Pennsylvania 17033 – sequence: 2 givenname: Silva A. surname: Arslanian fullname: Arslanian, Silva A. organization: 2Children's Hospital of Pittsburgh (S.A.A.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15224 – sequence: 3 givenname: David A. surname: Ehrmann fullname: Ehrmann, David A. organization: 3University of Chicago (D.A.E.), Chicago, Illinois 60637 – sequence: 4 givenname: Kathleen M. surname: Hoeger fullname: Hoeger, Kathleen M. organization: 4University of Rochester Medical Center (K.M.H.), Rochester, New York 14627 – sequence: 5 givenname: M. Hassan surname: Murad fullname: Murad, M. Hassan organization: 5Mayo Clinic (M.H.M.), Rochester, Minnesota 55905 – sequence: 6 givenname: Renato surname: Pasquali fullname: Pasquali, Renato organization: 6Orsola-Malpighi Hospital, University Alma Mater Studiorum, (R.P.), 40126 Bologna, Italy – sequence: 7 givenname: Corrine K. surname: Welt fullname: Welt, Corrine K. organization: 7Massachusetts General Hospital (C.K.W.), Boston, Massachusetts 02114 |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28032604$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/24151290$$D View this record in MEDLINE/PubMed |
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| Keywords | Obesity Endocrine gland Nutrition Nutrition disorder Female sterility Metabolic diseases Polycystic ovary Recommendation Female genital diseases Ovarian diseases Treatment Professional practice Cyst Benign neoplasm Diagnosis Society Endocrinology Nutritional status |
| Language | English |
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| References | 33882124 - J Clin Endocrinol Metab. 2021 May 13;106(6):e2462 |
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| SubjectTerms | Acne Adolescent Adolescents Adult Age Factors Androgens Apnea Biological and medical sciences Birth control Body weight loss Cardiovascular diseases Clinical practice guidelines Clomiphene Contraceptives Diabetes mellitus Diagnosis Endocrinology Endocrinopathies Evidence-Based Medicine Feeding. Feeding behavior Female Fundamental and applied biological sciences. Psychology Hirsutism Humans Infertility Medical diagnosis Medical sciences Menstruation Metformin Middle Aged Ovaries Phenotypes Polycystic ovary syndrome Polycystic Ovary Syndrome - diagnosis Polycystic Ovary Syndrome - physiopathology Polycystic Ovary Syndrome - therapy Post-menopause Risk factors Sleep disorders Societies, Scientific Statins Teenagers Thiazolidinediones Uterine cancer Vertebrates: anatomy and physiology, studies on body, several organs or systems Vertebrates: endocrinology |
| Title | Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline |
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