PCOS- Guideline Summary 2023
Polycystic Ovary Syndrome (PCOS) has been a focal point in women's health, and 2023 marks a significant turning point. With updated criteria for assessment, diagnosis, and treatment, our understanding of PCOS is evolving rapidly. Whether you're living with PCOS, a healthcare provider, or simply curious about women's health, staying current with the latest developments is crucial.
In this blog, we'll explore the 2023 updates in PCOS, focusing on diagnostic and treatment advancements that have the potential to change lives. Join us on this journey through the evolving landscape of PCOS as we uncover new insights and possibilities for the future of women's healthcare.
The diagnosis:
Adults:
Presence of any two:
- Clinical/biochemical Hyperandrogenism
- Ovulatory Dysfunction
- Polycystic ovaries on ultrasound or Elevated Anti-Mullerian Hormone (AMH) levels
Note:
In diagnosis of PCOS, other causes of the features (Clinical/biochemical Hyperandrogenism, Ovulatory Dysfunction, Polycystic ovaries on ultrasound or Elevated Anti-Mullerian Hormone (AMH) levels have to be excluded where irregular menstrual cycles and hyperandrogenism are present, in which ultrasound or AMH are not required for diagnosis.
(Exclusion of thyroid disease (thyroid stimulating hormone), hyperprolactinemia (prolactin), and non-classic congenital adrenal hyperplasia (17-hydroxyprogesterone) is recommended with further evaluation recommended in those with amenorrhea and more severe clinical features including consideration of hypogonadotropic hypogonadism, Cushing’s disease, or suspected androgen producing tumours, noting that overt virilisation is not consistent with PCOS.)
Adolescents:
- Hyperandrogenism (Must)
- Ovulatory Dysfunction (Must)
Note:
Ultrasound and AMH not recommended (Ultrasound and anti-mullerian (AMH) levels are not recommended in diagnosis in those within 8 years of menarche, young women 'at risk' can be identified, where diagnosis is unclear, with follow-up reassessment)
Approach:
Assessment and management should address reproductive, metabolic, cardiovascular, dermatologic, sleep and psychological features.
Fertility: A lifelong reproductive health plan is recommended including a focus on preconception risk factors, healthy lifestyle and prevention of weight gain and optimisation of fertility.
Metabolic: Metabolic risk factors, diabetes, cardiovascular disease and sleep disorders are all increased in PCOS. Screening and management is recommended.
Pregnancy: PCOS should be considered a high-risk condition in pregnancy with women identified and monitored.
Menopause: An increased premenopausal risk of endometrial cancer should be recognised, whilst absolute risks remain low.
Psychological Health: Depressive and anxiety symptoms are significantly increased and should be screened for in all women with PCOS, with psychological assessment and therapy as indicated.
Lifestyle Management: A healthy lifestyle remains vital throughout the lifespan in PCOS, with a strong focus on overall health, prevention of weight gain and if required, on weight management. Recognising the benefits of many specific diet and physical activity regimens, there is no one regimen that has benefits over others in PCOS.
Healthcare provider should remember:
- The value and optimal timing of assessment and diagnosis of PCOS should be discussed with the individual patient, considering psychosocial and cultural factors and preferences.
- Education is vitally important to women at the time of diagnosis, including reassurance about the potential for prevention of complications and about good general reproductive potential and family size, acknowledging some medical assistance may be required.
- As a general guiding principle, in partnering with women with PCOS in their diagnosis and care, self-empowerment is a priority and personal characteristics, preferences, culture and values should be considered when undertaking assessment, providing information or recommending intervention or treatments.
Diagnosis:
Healthcare professionals should use total and free testosterone to assess biochemical hyperandrogenism in the diagnosis of PCOS; free testosterone can be estimated by the calculated free androgen index.
The presence of hirsutism alone should be considered predictive of biochemical hyperandrogenism and PCOS in adults.
Healthcare professionals could recognise that female pattern hair loss and acne in isolation (without hirsutism) are relatively weak predictors of biochemical hyperandrogenism.
Follicle number per ovary (FNPO) should be considered the most effective ultrasound marker to detect polycystic ovarian morphology (PCOM) in adults.
Follicle number per ovary (FNPO), follicle number per cross-section (FNPS) and ovarian volume (OV) should be considered accurate ultrasound markers for PCOM in adults.
Anti-mullerian hormone in the diagnosis of PCOS:
Serum anti-mullerian hormone (AMH) could be used for defining PCOM in adults.
Serum AMH should only be used in accordance with the diagnostic algorithm, noting that in patients with irregular menstrual cycles and hyperandrogenism, an AMH level is not necessary for PCOS diagnosis.
We recommend that serum AMH should not be used as a single test for the diagnosis of PCOS.
Note: Serum AMH should not yet be used in adolescents.
Cardiovascular disease risk:
Women with PCOS should be considered at increased risk of cardiovascular disease and potentially of cardiovascular mortality, acknowledging that the overall risk of cardiovascular disease in premenopausal women is low.
All women with PCOS should be assessed for cardiovascular disease risk factors.
Impaired glucose tolerance and type 2 diabetes risk
Healthcare professionals and women with PCOS should be aware that, regardless of age and BMI, women with PCOS have an increased risk of impaired fasting glucose, impaired glucose tolerance and type 2 diabetes.
Glycaemic status should be assessed at diagnosis in all adults and adolescents
with PCOS.
Glycaemic testing
Healthcare professionals and women with PCOS should recommend the 75g oral glucose tolerance test (OGTT) as the most accurate test to assess glycaemic status in PCOS, regardless of BMI.
If an OGTT cannot be performed, fasting plasma glucose and/or glycated
haemoglobin (HbA1c) could be considered, noting significantly reduced accuracy.
Obstructive sleep apnea
Women with PCOS have significantly higher prevalence of obstructive sleep apnea (OSA) compared to women without PCOS, independent of BMI.
Women with PCOS should be assessed for symptoms (i.e. snoring in combination
with waking unrefreshed from sleep, daytime sleepiness
Endometrial hyperplasia and cancer
Healthcare professionals should be aware that premenopausal women with PCOS have markedly higher risk of developing endometrial hyperplasia and endometrial cancer.
Risks in relatives
Father and brothers of women with PCOS may have an increased prevalence of metabolic syndrome, type 2 diabetes, and hypertension.
Effectiveness of lifestyle interventions
Lifestyle intervention (exercise alone or multicomponent diet combined with exercise and behavioural strategies) should be recommended for all women with PCOS, for improving metabolic health including central adiposity and lipid profile.
Healthcare professionals and women should consider that there is no evidence to support any one type of diet composition over another for anthropometric,
metabolic, hormonal, reproductive or psychological outcomes.
Healthcare professionals and women could consider that there is a lack of evidence supporting any one type and intensity of exercise being better than another for
anthropometric, metabolic, hormonal, reproductive or psychological outcomes.
At Curate Health, our commitment to women's health remains unwavering. With these updated criteria in mind, we are more prepared than ever to help every woman facing PCOS. Our team of dedicated healthcare professionals is equipped with the latest knowledge and tools to provide accurate diagnoses and tailored treatment plans.
Our mission is to empower you to take control of your health and wellness. In the ever-evolving landscape of PCOS, one thing remains constant: Curate Health is here to be your partner in your journey towards better health. As we embrace these changes and advancements, we look forward to a future where women with PCOS can live their lives to the fullest, armed with knowledge, support, and the best possible care.
Feel free to reach out to Curate Health https://www.curate.health/ , where our doors are always open to guide, support, and curate your path to optimal health and well-being.Together, we'll continue to make strides in the world of women's healthcare, one step at a time.
