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International Evidence-Based Guideline for the Assessment International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018 Publication approval Publication history Original version 2011 – (National PCOS guideline) Updated version August 2015 – Aromatase inhibitors section update The guideline recommendations on pages 16 to 34 of this document were approved by the Chief Executive Officer of the National Health and Medical Updated, expanded and international Research Council (NHMRC) on 2 July 2018 under section 14A of the National current version February 2018 Health and Medical Research Council Act 1992. In approving the guideline recommendations, NHMRC considers that they meet the NHMRC standard for clinical practice guidelines. This approval is valid for a period of five years. Authorship NHMRC is satisfied that the guideline recommendations are systematically This guideline was authored by Helena Teede, derived, based on the identification and synthesis of the best available Marie Misso, Michael Costello, Anuja Dokras, scientific evidence, and developed for health professionals practising Joop Laven, Lisa Moran, Terhi Piltonen and in an Australian health care setting. Robert Norman on behalf of the International This publication reflects the views of the authors and not necessarily PCOS Network in collaboration with funding, the views of the Australian Government. partner and collaborating organisations, see Acknowledgments. Disclaimer Copyright information The Centre for Research Excellence in Polycystic Ovary Syndrome © Monash University on behalf of the NHMRC, (CREPCOS) research in partnership with the European Society of Centre for Research Excellence in PCOS and Human Reproduction and Embryology (ESHRE) and American Society the Australian PCOS Alliance 2018. of Reproductive Medicine (ASRM), and in collaboration with professional Paper-based publication: This work is societies and consumer advocacy groups internationally, developed the copyright. Apart from any use permitted under the evidence-based guideline to provide evidence-based recommendations Copyright Act 1968, no part may be reproduced to improve the quality of healthcare, health outcomes and quality of life of women with PCOS. The guideline represents the integration of the best by any process without written permission from evidence available at the time of preparation, multidisciplinary, international Monash University MCHRI-PCOS-Guideline- clinical perspectives and patient preferences. In the absence of scientific [email protected]. Elements of this guideline evidence in PCOS, evidence from the general population was considered and were updated from the 2011 PCOS guideline and a consensus between the engaged stakeholders was obtained. are included here with permission from the Jean Hailes Foundation for Women’s Health. The aim of evidenced-based guideline is to aid healthcare professionals and consumers in decisions about appropriate and effective care, although ISBN-13:978-0-646-98332-5 recommendations are generalised and application requires consideration of Electronic documents: This work is copyright. individual patient characteristics and preferences. All recommendations and You may download, display, print and reproduce practice points need to be considered in the context of regional regulations. this material in unaltered form only (retaining this Adherence to the guideline does not guarantee a successful or specific notice) for your personal, non-commercial use, outcome in an individual or override the healthcare professional’s clinical or use within your organisation. Apart from any judgment or patient preference in diagnosis and treatment of individual use as permitted under the Copyright Act 1968, patients. Ultimately, healthcare professionals must make their own clinical all other rights are reserved. decisions on a case-by-case basis, using their clinical judgment, knowledge, Copies of the guideline can be downloaded from and expertise, and taking into account the condition, circumstances, and monash.edu/medicine/sphpm/mchri/pcos. perspectives of the individual patient, in consultation with that patient and/or the guardian or carer. Suggested citation: International evidence- based guideline for the assessment and The guideline partners make no warranty, express or implied, regarding the management of polycystic ovary syndrome. guideline and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The partners shall not be liable for Copyright Monash University, direct, indirect, special, incidental, or consequential damages related to the Melbourne Australia 2018. use of the information contained herein. While the partners have made every effort to compile accurate current information, however we cannot guarantee the correctness, completeness, and accuracy of the guideline in every respect at all times. Guidelines do not necessarily represent the views of all clinicians that are members of the partner and collaborating societies. The information provided in this document does not constitute business, medical or other professional advice, and is subject to change. Acknowledgments We gratefully acknowledge the contribution of our engaged, funding, partner and collaborating organisations: 1 The Australian National Health and Medical Research Council (NHMRC) through the funded Centre for Research Excellence in Polycystic Ovary Syndrome (CREPCOS) (APP1078444) and the members of this Centre who led and co-ordinated this international guideline effort 2 Our partner organisations which co-funded the guideline: ● American Society for Reproductive Medicine (ASRM) ● European Society of Human Reproduction and Embryology (ESHRE) 3 Our collaborating and engaged societies and consumer groups: ● Androgen Excess and Polycystic Ovary Syndrome Society (AEPCOS) ● American Paediatric Endocrine Society ● Asia Pacific Paediatric Endocrine Society (APPES) ● Asia Pacific Initiative on Reproduction (ASPIRE) ● Australasian Paediatric Endocrine Group (APEG) ● Australian Diabetes Society (ADS) ● British Fertility Society (BFS) ● Canadian Society of Endocrinology and Metabolism (CSEM) ● Dietitians Association Australia (DAA) ● Endocrine Society (US Endo) ● Endocrine Society Australia (ESA) ● European Society of Endocrinology (ESE) ● European Society for Paediatric Endocrinology (ESPE) ● Exercise and Sports Science Australia (ESSA) ● Federation of Obstetric and Gynaecological Societies of India (FOGSI) ● Fertility Society Australia (FSA) ● International Society of Endocrinology (ISE) ● International Federation of Fertility Societies (IFFS) ● International Federation of Gynaecology and Obstetrics (FIGO) ● Italian Society of Gynaecology and Obstetrics (SIGO) ● Japanese Society for Paediatric Endocrinology (JSPE) ● Jean Hailes for Women's Health (Translation partner) ● Latin American Society for Paediatric Endocrinology (SLEP) ● Nordic Federation of Societies of Obstetrics and Gynaecology (NFOG) ● PCOS Challenge Inc: The National Polycystic Ovary Syndrome Association ● The PCOS Society (India) ● Paediatric Endocrine Society (PES) ● Polycystic Ovary Syndrome Association of Australia (POSAA) ● Royal Australasian College of Physicians (RACP) ● Royal Australian College of General Practitioners (RACGP) ● Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) ● Royal College of Obstetricians and Gynaecologists (RCOG) ● Society for Endocrinology (United Kingdom) ● South African Society of Gynaecology and Obstetrics (SASOG) ● Verity UK ● Victorian Assisted Reproductive Technology Association (VARTA) Other relevant organisations are welcome to partner in guideline translation once approved. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018 1 CONTENTS Contents Publication approval Screening, diagnostic assessment, Publication history risk assessment and life-stage 35 Disclaimer 1.1 Irregular cycles and ovulatory dysfunction 36 Authorship 1.2 Biochemical hyperandrogenism 38 Copyright information 1.3 Clinical hyperandrogenism 40 Acknowledgments 1 1.4 Ultrasound and polycystic ovarian morphology 42 1.5 Anti-Müllerian Hormone (AMH) 45 Contents 2 1.6 Ethnic variation 46 Preface 4 1.7 Menopause life-stage 47 Abstract 5 1.8 Cardiovascular disease 48 Executive Summary 6 1.9 Gestational diabetes, impaired glucose Context and background 6 tolerance and type 2 diabetes 50 Guideline purpose and aims 7 1.10 Obstructive sleep apnea 53 Key principles 8 1.11 Endometrial cancer 55 Patient population 8 Setting and audience 8 Chapter Two Governance 8 Prevalence, screening, diagnostic assessment and treatment of emotional wellbeing 57 Guideline Development Groups 10 2.1 Quality of life 58 Prioritised clinical questions 10 2.2 Depressive and anxiety symptoms, What the guideline does not address 10 screening and treatment 60 Guideline development methods 10 2.3 Psychosexual function 63 Community and consumer engagement 11 2.4 Body image 65 Funding 12 2.5 Eating disorders and disordered eating 67 Editorial independence and disclosures of interest 12 2.6 Information resources, models of care, Guideline translation 12 cultural and linguistic considerations 69 Interpreting the recommendations 14 Chapter Three Recommendations Summary 16 Lifestyle 72 Chapter One 3.1 Effectiveness of lifestyle interventions 73 3.2 Behavioural interventions 75 3.3 Dietary interventions 77 3.4 Exercise interventions 79 3.5 Obesity and weight assessment 82 2 CONTENTS Chapter Four Chapter Six Pharmacological treatment
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