A single voice for PCOS

PCOS affects many Australian women, with most remaining undiagnosed. A new guideline outlines diagnosis and management.

Introduction

DIAGNOSIS of polycystic ovary syndrome (PCOS), based on the 2003 Rotterdam criteria, requires two of three features: oligo or amenorrhoea, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound,1,2 with exclusion of secondary causes. 

PCOS has recently been shown to affect 12–18% of women depending on the population studied and diagnostic criteria used, highlighting that PCOS is of clinical and public health importance,3 with considerable health and economic costs.

PCOS can present with features that include:

• reproductive (hyperandrogenism, hirsutism, anovulation, infertility)

• metabolic (insulin resistance, prediabetes, type 2 diabetes, adverse cardiovascular risk profiles) 

• psychological features (anxiety and depression).4


There is considerable heterogeneity in clinical presentation, which also varies across the life cycle. Obesity exacerbates the incidence, prevalence and severity of PCOS, and weight loss improves clinical features. Hence, lifestyle change is first-line PCOS therapy.5, 6

An estimated 70% of Australian women with PCOS remain undiagnosed,3 clinical practice is often inconsistent,7 and most services are unable to optimally address lifestyle, psychological issues and prevention of complications.8

The PCOS Australian Alliance

In this setting, an independent PCOS Australian Alliance was formed in 2008. The alliance included key research, multidisciplinary clinical and consumer groups through the national support group, Polycystic Ovary Syndrome Association of Australia (POSAA). 

The vision of the PCOS Australian Alliance is to improve the lives of Australian women with PCOS through leadership and cohesion to promote education, research and to support consistent, evidence based, multidisciplinary service provision.

 An evidence-based guideline, research, translation, cross-sector collaboration, community partnerships and interactions with government and policy makers were all identified as priorities aimed at prevention and management of PCOS within Australia.9

PCOS evidence-based guideline

The scope of the PCOS guideline was developed based on the highest clinical priority, greatest knowledge gaps, priorities identified by the commissioning Australian government and expertise of Alliance members. Areas covered include:9

• challenges in the diagnosis and assessment of PCOS 

• assessment of emotional wellbeing 

• lifestyle management in PCOS, including dietary and exercise interventions

• management of infertility, including non-pharmacological, pharmacological and surgical options.

The purpose of the guideline is to integrate the best available evidence with clinical expertise and consumer preferences to provide health professionals, consumers and policy makers with guidance on accurate assessment, timely diagnosis and optimal management of PCOS. 

It also promotes optimal, consistent, evidence-based treatment with a focus on prevention of complications in both primary care and specialist settings.9

This guideline was developed using the National Health and Medical Research Council (NHMRC) standards and procedures for externally developed guidelines10 and has now been approved by the NHMRC. 

Public and targeted consultation during both the scoping and final stages of guideline development included consumers via POSAA, as well as specialist colleges including the Royal Australian College of General Practitioners (RACGP) and specialist societies both nationally and internationally. 

This important national guideline was officially launched at the Endocrine Society of Australia’s Annual Scientific Meeting in August 2011. 

The full guideline, methodology (including process for obtaining NHMRC approval), evidence report and consumer and health professional resources is available on the Jean Hailes PCOS website. 

A targeted clinical summary for health professionals is available in the September issue of the Medical Journal of Australia. Additional consumer and health professional resources are available at www.managingpcos.org.au

Jean Hailes Foundation for Women’s Health is a national, non-profit health organisation focusing on healthcare, innovative research and practical educational opportunities for health professionals and women.

Dr Anju Joham, MBBS, FRACP

Endocrinologist, Southern Health;

PhD student, Jean Hailes Research, School of Public Health and Preventive Medicine, Monash University

Co-author: Professor Helena TeedeMBBS, FRACP, PhD

Director of research, the Jean Hailes Foundation for Women’s Health; 

Professor of women’s health and Monash site director, School of Public Health and Preventive Medicine, Monash University;

Head of Diabetes Unit, Southern Health;

NHMRC CDA Fellow

References

1.    Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet. 2007 Aug 25;370(9588):685-97.
2.    Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004 Jan;81(1):19-25.
3.    March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010 Feb;25(2):544-51.
4.    Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41.
5.    Norman RJ, Davies MJ, Lord JM, Moran LJ. The role of lifestyle modifications in polycystic ovary syndrome. Trends Endocrinol Metab. 2002;13:235 - 7.
6.    Norman RJ, Wu R, Stankiewicz MT. Polycystic ovary syndrome. Medical Journal of Australia. [Review]. 2004;180:132-7.
7.    Cussons AJ, Stuckey BGA, Walsh JP, Burke V, Norman RJ. Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management. Clin Endocrinol (Oxf). 2005 Mar;62(3):289-95.
8.    Deeks AA, Gibson-Helm ME, Teede HJ. Anxiety and depression in polycystic ovary syndrome: a comprehensive investigation. Fertil Steril. 2010 May 1;93(7):2421-3.
9.    Evidence-based guideline for the assessment and management of polycystic ovary syndrome. Melbourne: Jean Hailes Foundation for Women’s Health on behalf of the PCOS Australian Alliance,  2011.
10.    NHMRC. NHMRC standards and procedures for externally developed guidelines.  National Health and Medical Research Council (NHMRC), Editor. Australia2007.