Clinical practice guidelines on the diagnosis and management of polycystic ovary syndrome (PCOS) from the International PCOS Network were published in October 2023 in Fertility and Sterility.[1]
The diagnosis of PCOS is made on the basis of two of the following three criteria: (1) clinical and/or biochemical evidence of hyperandrogenism, (2) ovulatory dysfunction, and (3) polycystic ovaries as indicated by ultrasound examination or anti-Müllerian hormone (AMH) level in adults. Note that neither ultrasound examination nor measurement of serum AMH is recommended in adolescents because of poor specificity in this age group.
PCOS can be diagnosed in patients who have both irregular menstrual cycles and hyperandrogenism. In such patients, neither an ovarian ultrasound scan nor an AMH level is required for the diagnosis.
Testing for biochemical hyperandrogenism should include measurement of total and free testosterone levels. The calculated free androgen index can be used to estimate the free testosterone level.
For management of irregular menstrual cycles and/or hirsutism, combined oral contraceptive pills are the first-line pharmacologic option. No specific oral contraceptive is recommended; however, preparations with a lower dose of ethinyl estradiol and fewer adverse effects are preferred.
The use of metformin alone is recommended for adults who have a body mass index of 25 kg/m2 or higher primarily to manage the metabolic features of PCOS, such as insulin resistance and glucose and lipid levels. Metformin is preferred over inositol, which has limited effects on hirsutism, weight, and ovulation in patients with PCOS.
For more information, please go to Polycystic Ovarian Syndrome.
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