Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline

    Richard S. Legro, Silva Arslanian, David A. Ehrmann, Kathleen Hoeger, M. Hassan Murad, Renato Pasquali, Corrine K. Welt
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    TLDR The guideline suggests using specific criteria to diagnose PCOS, recommends various treatments for its symptoms, and advises screening for related health issues.
    The Endocrine Society's Clinical Practice Guideline from 2013 provided recommendations for diagnosing and treating Polycystic Ovary Syndrome (PCOS). Diagnosis should follow the Rotterdam criteria, requiring two of the following three features: androgen excess, ovulatory dysfunction, or polycystic ovaries, after ruling out other similar disorders. Adolescents should be diagnosed based on clinical or biochemical evidence of hyperandrogenism and persistent oligomenorrhea. In perimenopausal and menopausal women, a history of oligomenorrhea and hyperandrogenism can lead to a presumptive diagnosis. The guideline recommended hormonal contraceptives for menstrual abnormalities and hirsutism/acne, clomiphene for infertility, and metformin for metabolic issues and menstrual irregularities, but not for hirsutism, acne, or infertility. Weight loss was encouraged for health benefits in overweight/obese patients, but its effects on PCOS were uncertain. Thiazolidinediones were not recommended due to unfavorable risk-benefit ratios, and further research on statins was needed. Screening for associated conditions like obesity, depression, and cardiovascular risk factors was advised, and the importance of lifestyle interventions was emphasized. The guideline was based on the best available evidence at the time, following the GRADE approach.
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