PCOS draft guidelines out for consultation

Draft international guidelines on the assessment and management of polycystic ovary syndrome (PCOS), auspiced by the Australian Centre for Research Excellence in PCOS, are now open for public consultation.

CRE co-director and project chair Professor Helena Teede told the limbic the rigorous development process has included engagement with thousands of women with PCOS, health professionals and more than 40 partner and collaborating societies.

Consultation with women with PCOS highlighted concerns such as delay in diagnosis, inconsistency of care, lack of appreciation of the diversity of the condition, high levels of dissatisfaction with care and inadequate information and support.

“The biggest issue that patients have is around prompt early diagnosis and also getting lifestyle and psychological management. They may get their infertility managed but they don’t get other critical components of the condition managed.”

The guidelines hope to overcome concerns about inconsistent diagnosis and treatment, she said.

“The main things that have changed are a much greater focus on diagnosis. So the primary diagnostic features are clinical hyperandrogenism and if that’s not present, then biochemical tests.”

“So in fact the guidelines have really simplified the diagnosis, not made it more complex. You need less tests and you do it in a sequence at much lower cost.”

One of the ongoing areas of controversy has been resolved with the draft guidelines recommending against ultrasound in adolescents.

“We actually recommend against ultrasound before 20 years of age because that’s where the problem starts; polycystic ovaries are normal in adolescents.”

Given the improved sensitivity of ultrasound in recent years, the guidelines have also increased the number of follicles as the threshold for polycystic ovarian morphology.

Professor Teede said treatment guidelines were also much clearer.

“Metformin has much more of a role than it did in other guidelines. And we’ve also recommended a different first line treatment for infertility. Letrozole was previously second line but the evidence is much more compelling now.”

Professor Teede said the guidelines also recognized that women sometimes did not want to be dealing with a myriad of different health professionals.

“Where appropriate and where needed the guidelines will suggest the support of an allied health professional but they have also been written to give women and their doctors enough of that information so that a lot [of lifestyle issues] can be addressed at their level.”

She added that an extensive translation program for the final guidelines was ready to be rolled out including a patient app and society accredited online training programs for health professionals.

Consultation is open until 12 March 2018.


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