An update of the international guideline on PCOS

Joop Laven

An update of the international guideline on PCOS

Joop S.E. Laven, M.D., Ph.D., Div. Reproductive Endocrinology & Infertility, Dept OBGYN, Erasmus MC, Rotterdam, The Netherlands.

On behalf of the guideline development group: Teede HJ, Tay CT, Dokras A, Moran LJ, Piltonen TT, Costello MF, Boivin J, Redman LM, Boyle JA, Norman RJ, Mousa A, Joham AE.

Abstract:

The International evidence-based guidelines address prioritized questions and outcomes and include 254 recommendations and practice points, to promote consistent, evidence-based care and improve the experience and health outcomes in PCOS.

The evidence in the assessment and management of PCOS has generally improved in the past 5 years but remains of low to moderate quality. The technical evidence report and analyses (∼6000 pages) underpin 77 evidence-based and 54 consensus recommendations, with 123 practice points.

Key updates include the following: (1) further refinement of individual diagnostic criteria, a simplified diagnostic algorithm, and inclusion of anti-Müllerian hormone levels as an alternative to ultrasound in adults only; (2) strengthening recognition of broader features of PCOS including metabolic risk factors, cardiovascular disease, sleep apnea, very high prevalence of psychological features, and high risk status for adverse outcomes during pregnancy; (3) emphasizing the poorly recognized, diverse burden of disease and the need for greater healthcare professional education, evidence-based patient information, improved models of care, and shared decision-making to improve patient experience, alongside greater research; (4) maintained emphasis on healthy lifestyle, emotional well-being, and quality of life, with awareness and consideration of weight stigma; and (5) emphasizing evidence-based medical therapy and cheaper and safer fertility management.

Overall, recommendations are strengthened and evidence is improved but remains generally low to moderate quality. Significantly greater research is now needed in this neglected, yet common condition. Regional health system variation was considered and acknowledged, with a further process for guideline and translation resource adaptation provided.

Key Words:

GRADE; assessment; evidence based; guideline; management; polycystic ovary syndrome (PCOS).

Joop Laven

Professor Joop S.E. Laven is professor in Reproductive Endocrinology and Infertility based at Erasmus Medical Centre, Rotterdam in the Netherlands and was initially trained at the University of Utrecht in the same country. After Medical school he completed his Ph.D. thesis on clinical and experimental aspects of varicocele at Utrecht University in 1991. From 1991 till 1997 he continued his training at the University Medical Center St. Radboud in Nijmegen. In 1997 he became board certified in OBGYN (FRCOG) and moved to the Erasmus Medical Center in Rotterdam. In 2000 he became certified subspecialist Reproductive Medicine. He is a member of ESHRE, ASRM, the Endocrine Society, the Society of Gynecological Investigation (SGI) and the Royal Dutch College of Obstetrics and Gynecology. He is the past president of the Dutch Society of Reproductive Medicine. He is the president-elect of AE-PCOS society For many years he had a particular interest in the management of polycystic ovary syndrome covering the full spectrum from the effects of the syndrome during adolescence and adult life on the menstrual cycle, fertility, body weight and cosmetic aspects. During the last decade the research focussed on more fundamental effects that PCOS may have on quality of life and long-term health risks as well as the genetic basis of the disease. More recently he was also involved in Genome Wide Association Studies (GWAS) exploring the genetic basis of PCOS, premature ovarian insufficiency, menarche and menopause. He has published over 350 peer-reviewed papers and several reviews as well as chapters in books, and has delivered over 400 lectures to international scientific audiences. He is a past member of the editorial board of Human Reproduction Update, Human Reproduction and the Journal of Endocrine Society. He is a visiting professor at the University of Shandong, Shandong, China and the University of Adelaide, Australia. He is also a member of the international guideline groups for PCOS, POI and unexplained infertility within the Center of Research Excellence (WHIRL) Monash University, Melbourne, Australia.