ESPE Abstracts (2018) 89 P-P1-235

Diagnosis of Adolescent Polycystic Ovary Syndrome (PCOS) According to the 2018 International Evidence-Based Guideline for the Assessment and Management of PCOS

Alexia Peñaa,b, Kathy Hoegerc, Sharon Oberfieldd, Selma Wiitchele, Maria Vogiatzif, Marie Missog & Helena Teedeg

aThe University of Adelaide, Discipline of Paediatrics, Adelaide, Australia; bWomen’s and Children’s Hospital - Endocrine and Diabetes, North Adelaide, Australia; cUniversity of Rochester School of Medicine and Dentistry, Rochester, USA; dColumbia University Medical Centre, New York, USA; eChildren’s Hospital of Pittsburgh of University of Pittsburgh Medical Centre, Pittsburgh, USA; fChildren’s Hospital of Philadelphia, Philadelphia, USA; gMonash Centre for Health Research and Implementation Monash University, Melbourne, Australia

The diagnosis of Polycystic Ovary Syndrome (PCOS) during adolescence is controversial with adult diagnostic features overlapping with normal physiological events that occur during puberty. The aim of international evidence-based guideline was to promote accurate diagnosis, optimal consistent care, prevention of complications and improve patient experience and health outcomes. Extensive international health professional and patient engagement informed the priorities and core outcomes for the guideline. International nominated panels including women with PCOS, multidisciplinary team of health care professionals (across 44 societies and 71 countries), researchers and an evidence synthesis and translation team developed the guideline that was funded and led by Australia. The evidence-based guideline development followed international best practice involving 60 systematic and narrative reviews and applying full Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework to reflect quality of the evidence, and consider feasibility, acceptability, cost, implementation and the strength of recommendations. Adolescent recommendations for PCOS diagnosis aimed to avoid over diagnosis, misdiagnosis and delay and under diagnosis; and include:

1. Irregular menstrual cycles are:

– in the first year post menarche, a normal part of the pubertal transition

– >1 to <3 years post menarche: <21 or >45 days

– >3 years post menarche to perimenopause: <21 or >35 days or <8 cycles per year

– >1 year post menarche >90 days for any one cycle

– Primary amenorrhea by age 15 or >3 years post thelarche

When irregular menstrual cycles are present a diagnosis of PCOS should be considered and assessed according to the guidelines.

2. Clinical hyperandrogenism should focus on hirsutism using scoring tools, not on mild to moderate acne that is common in adolescence, or alopecia. Where clinical hyperandrogenism is not present, biochemical hyperandrogenemia testing is appropriate using high quality assays.

3. Pelvic ultrasound and anti-mullerian hormone measurement are not recommended for PCOS diagnosis during adolescence.

4. Exclusion of other disorders that mimic PCOS is required in all women but particularly in those with amenorrhea and severe phenotypes.

For adolescents who have features of PCOS but do not meet diagnostic criteria, an ‘increased risk’ could be considered and reassessment advised at or before full reproductive maturity, 8 years post menarche. This includes those with features of PCOS before contraceptive pill commencement, those with persisting features and those with significant weight gain. The value and optimal timing of assessment and diagnosis of PCOS should be discussed with the individual patient, taking into account diagnostic challenges at this life stage and psychosocial and cultural factors.

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