Diagnosis and Treatment of Polycystic Ovary Syndrome

Full Guideline: Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline
JCEM December 2013

Richard S. Legro, Silva A. Arslanian, David A. Ehrmann, Kathleen M. Hoeger, M. Hassan Murad, Renato Pasquali, Corrine K. Welt

Objective:

The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS).

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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