ESPE Abstracts (2018) 89 RFC8.3

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

Alexia Penaa,b, Selma Witchelc, Kathy Hoegerd, Sharon Oberfielde, Maria Vogiatzif, Marie Missog & Helena Teedeg

aThe University of Adelaide, Adelaide, Australia; bWomen’s and Children’s Hospital - Endocrine and Diabetes, North Adelaide, Australia; cChildren’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA; dUniversity of Rochester School of Medicine and Dentistry, Rochester, New York, USA; eColumbia Unversity Medical Center, New York, New York, USA; fChildren’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; gMonash Centre for Health Research and Implementation Monash University, Melbourne, Australia

The treatment of Polycystic Ovary Syndrome (PCOS) during adolescence is controversial. The aim of the international evidence-based guideline was to promote accurate diagnosis, optimal consistent care, prevention of complications and to improve patient experience and health outcomes. Extensive international health professional and patient engagement informed the priorities and core outcomes for the guideline. Internationally nominated panels including women with PCOS and a multidisciplinary team of health care professionals (across 44 societies-71 countries), researchers and an evidence synthesis team developed the guideline 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 considered feasibility, acceptability, cost, implementation and the strength of recommendations. Principles of treatment:

• Consideration of the individual’s personal characteristics, preferences and values is important in recommending pharmacotherapy.

• Combined oral contraceptive pill (COCP), metformin and other medications are generally off label for PCOS. However off label use is evidence-based and is allowed in many countries. Where is it allowed, health professionals should inform patients and discuss the evidence, possible concerns and treatment side effects.

• Antiandrogens must be used with effective contraception.

• Holistic approaches are required and pharmacotherapy in PCOS should be considered alongside education, lifestyle (behavioural, diet and exercise) and other options including cosmetic therapy and counselling.

In Adolescents, evidence based recommendations for PCOS pharmacological treatment include:


• COCP alone should be considered in adolescents with a clear PCOS diagnosis or those who are deemed ‘at risk’ of PCOS for management of clinical hyperandrogenism and/or irregular menstrual cycles.

• pecific types or doses of progestins, estrogens or combinations of COCP cannot currently be recommended with inadequate evidence in women and adolescents with PCOS and practice should be informed by general population guidelines.

• COCP in combination with metformin could be considered in adolescents with PCOS and BMI >25 kg/m2.

• In combination with COCP, antiandrogens should only be considered in PCOS to treat hirsutism, after 6 months or more of COCP and cosmetic therapy have failed.

2) Metformin in addition to lifestyle, could be considered in adolescents with a clear PCOS diagnosis or with symptoms of PCOS before diagnosis is made.

3) Inositol should be considered an experimental therapy for women with PCOS.

These guidelines are subject to extensive translation including a personalised patient app and certified online health professional training programs.

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