Simplify Your Approach to the Diagnosis and Treatment of PCOS

    December 2022 in “ OBG Management ”
    Robert L. Barbieri
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    TLDR The conclusion is to diagnose PCOS with just hyperandrogenism and irregular periods, and treat with lifestyle changes and basic medications.
    The document suggests simplifying the diagnosis of polycystic ovary syndrome (PCOS) by focusing on two core criteria: hyperandrogenism and oligo-ovulation. PCOS is a common problem affecting 6% to 10% of women of reproductive age, often presenting with symptoms such as hirsutism, acne, female androgenetic alopecia, infrequent menstrual bleeding, infertility, overweight, or obesity. The document criticizes the Rotterdam approach to diagnosing PCOS, which includes ultrasound imaging, due to its complexity, cost, and potential for misdiagnosis. Instead, it recommends returning to the 1990 National Institutes of Health (NIH) criteria, which bases the diagnosis on history and physical examination. The document also suggests simplifying the treatment of PCOS by counseling about lifestyle changes and prescribing an estrogen-progestin contraceptive, with spironolactone and/or metformin.
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