Endocrine Society releases PCOS guidelines

The Endocrine Society's new clinical practice guideline on polycystic ovary syndrome (PCOS) recommends diagnosis based on two of three key features of he condition. The advice, published in the Journal of Clinical Endocrinology and Metabolism, is aimed at reducing the need for ultrasound or hormone tests in patient evaluation.

The panel, led by Richard S. Legro, MD, of the Penn State University College of Medicine, developed the guideline by using the Grading of Recommendations, Assessment, Development, and Evaluation system.

The guidelines suggest using the Rotterdam criteria, which require the presence of two of the following: androgen excess, ovulatory dysfunction, and polycycstic ovaries. When evaluating women for PCOS, physicians should exclude other androgen-excess conditions as well as risk factors for obstructive apnea, diabetes, cardiovascular disease, endometrial cancer, and mood disorders. Clomiphene is the the first-line therapy for infertility, while metformin can help with metabolic/glycemic abnormalities and menstrual irregularities. The effect of weight loss on PCOS is unknown, but recommending it to overweight or obese patients provides other health benefits.

The diagnosis of PCOS, the guidelines note, can prove problematic in adolescents or menopausal women. No consistent phenotype exists for postmenopausal women, but hyperandrogenism is key to a PCOS presentation in adolescents. Hormonal contraceptives are recommended in the guidelines for management of menstrual abnormalities, hirsuitism and acne associated with PCOS, whereas metformin is the best treatment for adolescents.

The guidelines also state that thiazolidinedones should not be used for treatment because of an unfavorable risk-benefit ratio. The role of statins in the treatment of PCOS is unknown and requires further study.

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