ESPE Abstracts

Objective: The original consensus-based Rotterdam criteria, now evidence-based criteria, is recommended for the diagnosis of PCOS in adult women. These criteria state that PCOS can be diagnosed when two of three major criteria (anovulatory cycles, clinical/biochemical hyperandrogenism, and polycystic ovary morphology or elevated AMH levels) are present and other potential etiologies have been excluded. Use of these criteria in adolescent girls is problematic because adolescent girls commonly experience irregular menses, acne, and multi-follicular ovaries. Using best practice guideline methods, rigorous updated comprehensive evidence-based guidelines for diagnosis, assessment and treatment for adolescent women with polycystic ovary syndrome (PCOS) were developed.

Methods: Governance involved an international advisory board, project board and five guideline development groups with 52 members representing 36 organisations across 6 continents. Health professionals and patients/consumers performed extensive meta-analyses and evidence synthesis of 55 prioritised clinical questions. This process involved best practice evidence-based guideline development and extensive evidence synthesis following review of available clinical studies. The GRADE framework covered evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength.

Results: This process generated evidence-based and consensus recommendations with clinical practice points. For adolescent girls who are >2 years post-menarche, PCOS can be diagnosed based on ovulatory dysfunction and clinical/biochemical hyperandrogenism following exclusion of other disorders. Girls with symptoms typical of PCOS who do not meet criteria can be considered as “at risk for PCOS”. Pelvic ultrasound is not recommended until 8 years post-menarche for PCOS diagnosis. Due to poor specificity, AMH levels are not recommended in adolescence. Health professionals and patients should address viable treatment options and management of psychological and physical PCOS features using a shared decision-making approach.

Conclusions: A lifelong health plan is recommended focusing on overall health, prevention of weight gain, and weight management. Weight bias and stigma should be minimized, and healthcare professionals should seek permission to weigh women with explanation of weight related risks. Combined oral contraceptive pills are first line pharmacological treatment for menstrual irregularity and hyperandrogenism, with no specific recommended preparation, and a preference for lower dose preparations and those with fewer side-effects. Metformin is recommended primarily for metabolic features. No specific diet or physical activity regimen has benefits over others in PCOS. Overall evidence in PCOS is low to moderate quality. Based on high prevalence and significant health impact, greater priority for funding and research in PCOS alongside education for health professionals and those affected by PCOS is urged.