Diagnosis and Treatment of Polycystic Ovary Syndrome

 

The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS).

 

An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline.

 

This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.

 

One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematic reviews were conducted to summarize supporting evidence.

 

We suggest using the Rotterdam criteria for diagnosing PCOS (presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries). Establishing a diagnosis of PCOS is problematic in adolescents and menopausal women. Hyperandrogenism is central to the presentation in adolescents, whereas there is no consistent phenotype in postmenopausal women. Evaluation of women with PCOS should exclude alternate androgen-excess disorders and risk factors for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease. Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS. Clomiphene is currently the first-line therapy for infertility; metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities, but it has limited or no benefit in treating hirsutism, acne, or infertility. Hormonal contraceptives and metformin are the treatment options in adolescents with PCOS. The role of weight loss in improving PCOS status per se is uncertain, but lifestyle intervention is beneficial in overweight/obese patients for other health benefits. Thiazolidinediones have an unfavorable risk-benefit ratio overall, and statins require further study.

Target Audience

This continuing medical education activity should be of substantial interest to endocrinologists and other health care professionals that treat patients with PCOS.

Learning Objectives

Upon completion of this educational activity, learners will be able to:

  • Evaluate patients and perform differential diagnosis to distinguish PCOS from other menstrual disorders.
  • Identify the lack of accepted diagnostic criteria in adolescents with PCOS.
  • Identify appropriate treatment for a woman with PCOS to address clinical hyperandrogenism and menstrual irregularity.
  • Identify adverse risk factors and potential benefits for OCP use in women with PCOS.
  • Identify risk factors for serious adverse events for thromboembolism and related cardiovascular events in women taking hormonal contraceptives.

Additional Information

Target Audience: 
Physician-in-practice
Fellow
Resident
Clinical researcher
Scientific researcher
Educator/Teacher
Pharmacist
Nurse/Nurse practitioner
Physician assistant
Allied health professional
Other
Competency Area: 
Professionalism
Patient Care and Procedural Skills
Medical Knowledge
Topic Area: 
General Endocrinology
Women’s Health
Level of Outcomes: 
Level 1 (Participation)
Level 2 (Satisfaction)
Level 3A (Learning: Declarative Knowledge (Knows))
Level 3B (Learning: Procedural Knowledge (Knows How))
Level 4 (Learning: Competence (Shows How))
Activity summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credits
  • 2.00 CME Certificate of Participation
Course opens: 
11/01/2013
Course expires: 
11/30/2016
Rating: 
0

STATEMENT OF INDEPENDENCE

As a provider of continuing medical education (CME) accredited by the Accreditation Council for Continuing Medical Education, The Endocrine Society has a policy of ensuring that the content and quality of this educational activity are balanced, independent, objective, and scientifically rigorous. The scientific content of this activity was developed under the supervision of The PCOS Guidelines Task Force.

DISCLOSURE POLICY

The faculty, committee members, and staff who are in position to control the content of this activity are required to disclose to The Endocrine Society and to learners any relevant financial relationship(s) of the individual or spouse/partner that have occurred within the last 12 months with any commercial interest(s) whose products or services are related to the CME content. Financial relationships are defined by remuneration in any amount from the commercial interest(s) in the form of grants; research support; consulting fees; salary; ownership interest (e.g., stocks, stock options, or ownership interest excluding diversified mutual funds); honoraria or other payments for participation in speakers' bureaus, advisory boards, or boards of directors; or other financial benefits. The intent of this disclosure is not to prevent CME planners with relevant financial relationships from planning or delivery of content, but rather to provide learners with information that allows them to make their own judgments of whether these financial relationships may have influenced the educational activity with regard to exposition or conclusion.

The Endocrine Society has reviewed all disclosures and resolved or managed all identified conflicts of interest, as applicable.

The following task force members who planned and/or reviewed content for this activity reported relevant financial relationships:


Silva A. Arslanian, MD is on the advisory board for Sanofi-Aventis, Novo Nordisk and Bristol-Myers Squibb. She is a consultant for GILEAD and Boehringer Engelheim.

David A. Ehrmann, MD is on the advisory board for Astra-Zeneca.

Corrine K. Welt, MD is a consultant for Astra-Zeneca.

The following committee members who planned and/or reviewed content for this activity reported no relevant financial relationships: Richard S. Legro, MD (chair); M. Hassan Murad, MD; Kathleen M. Hoeger; and Renato Pasquali, MD

Endocrine Society staff associated with the development of content for this activity reported no relevant financial relationships.

Use of professional judgment:

The educational content in this activity relates to basic principles of diagnosis and therapy and does not substitute for individual patient assessment based on the health care provider’s examination of the patient and consideration of laboratory data and other factors unique to the patient. Standards in medicine change as new data become available.

Drugs and dosages:

When prescribing medications, the physician is advised to check the product information sheet accompanying each drug to verify conditions of use and to identify any changes in drug dosage schedule or contraindications.

POLICY ON UNLABELED/OFF-LABEL USE

The Endocrine Society has determined that disclosure of unlabeled/off-label or investigational use of commercial product(s) is informative for audiences and therefore requires this information to be disclosed to the learners at the beginning of the presentation. Uses of specific therapeutic agents, devices, and other products discussed in this educational activity may not be the same as those indicated in product labeling approved by the Food and Drug Administration (FDA). The Endocrine Society requires that any discussions of such “off-label” use be based on scientific research that conforms to generally accepted standards of experimental design, data collection, and data analysis. Before recommending or prescribing any therapeutic agent or device, learners should review the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse events.

PRIVACY AND CONFIDENTIALITY STATEMENT

The Endocrine Society will record learner's personal information as provided on CME evaluations to allow for issuance and tracking of CME certificates. The Endocrine Society may also track aggregate responses to questions in activities and evaluations and use these data to inform the ongoing evaluation and improvement of its CME program. No individual performance data or any other personal information collected from evaluations will be shared with third parties.

ACKNOWLEDGEMENT OF COMMERCIAL SUPPORT

This activity is not supported by educational grant(s) from commercial supporters.

Available Credit

  • 2.00 AMA PRA Category 1 Credits
  • 2.00 CME Certificate of Participation

Accreditation Period

Course opens: 
11/01/2013
Course expires: 
11/30/2016