• Polycystic Ovary Disorder
• Diabetes & Endocrinology Guidelines

• Endocrinology
• Diabetes & Metabolic Syndrome
• Polycystic Ovary Disorder
• Diabetes & Endocrinology Guidelines

The goal of The Endocrine Society's clinical practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS) is to address the diagnosis and treatment of PCOS from adolescence to adulthood while avoiding overlap with any other Endocrine Society guidelines for disorders related to PCOS (eg, hirsutism). Richard S. Legro, MD, Penn State Hershey Obstetrics and Gynecology, Hershey, Pennsylvania, USA, discussed aspects of diagnosis of PCOS contained within the new guidelines.

There are currently 3 overlapping, yet unique, diagnostic criteria for PCOS: the National Institutes of Health (NIH) criteria, the “Rotterdam” criteria, and the Androgen Excess and Polycystic Ovary Syndrome Society (AES/PCOS) criteria. The Endocrine Society favors using the broader Rotterdam criteria, which encompasses the NIH and AES/PCOS criteria. However, phenotypic heterogeneity is present; for example, patients with hyperandrogenism typically experience more severe reproductive and metabolic symptoms than those without hyperandrogenism.

PCOS is associated with multiple morbidities, including infertility, obesity, cutaneous symptoms including acne and androgenic alopecia, mood disorders, sleep disorders, abnormal liver function, and a greater risk for cardiovascular disease.

Commonly employed treatments for PCOS include hormonal contraceptives, insulin sensitizers (eg, metformin), and antiandrogens. There are some controversies as to the safety and efficacy of these therapies. In a systemic review and meta-analysis of the adverse effects associated with PCOS treatment, common therapies for PCOS (above) were correlated with a low risk of severe adverse events [Domecq JP et al. J Clin Endocrinol Metab 2013]. A meta-analysis of lifestyle modifications in patients with PCOS demonstrated that lifestyle modifications reduce insulin resistance in overweight or obese patients [Prutsky G et al. J Clin Endocrinol Metab 2013]. In part based on this evidence, The Endocrine Society recommends (a) clomiphene citrate as the first-line therapy for infertility, (b) hormonal contraceptives as first-line for menstrual irregularities and hirsutism, and (c) lifestyle modifications (eg, exercise; calorie-restricted diet in the setting of overweight/obesity) as needed to improve cardiovascular disease risk factors. The Endocrine Society recommends that metformin be used as a second-line therapy in women with type 2 diabetes or impaired glucose tolerance who do not achieve adequate benefit with lifestyle modifications. In addition, PCOS patients with menstrual irregularities may be candidates for metformin therapy if they cannot take or do not tolerate hormonal contraceptives.

The treatment of PCOS in adolescence is less clear, as there are less data on which to base recommendations. In this population, the diagnostic focus should be on hyperandrogenism because oligo-ovulation and polycystic ovaries are often normal during reproductive development in adolescence. Suggested treatment approaches for well-established adolescent PCOS are similar to those for adults. When clinical and biochemical hyperandrogenism occurs in premenarcheal adolescents who are at least Tanner breast stage 4 (and other causes are excluded), treatment with hormonal contraceptives is suggested.

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