Table of contents
Polycystic ovary syndrome
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of polycystic ovary syndrome are prepared by our editorial team based on guidelines from the American Diabetes Association (ADA 2024), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2023,2018), the Endocrine Society (ES 2020,2013), the American College of Obstetricians and Gynecologists (ACOG 2018), the American Society for Reproductive Medicine (ASRM ...
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Screening and diagnosis
Diagnostic criteria: as per RCOG 2014 guidelines, diagnose PCOS according to the Rotterdam consensus criteria.
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Differential diagnosis
Diagnostic investigations
History and physical examination: as per ES 2013 guidelines, screen for ovulatory status using menstrual history in all patients with PCOS seeking fertility. Recognize that some patients with PCOS and a eumenorrheic menstrual history may still experience anovulation, thus consider obtaining a midluteal serum progesterone level as an additional screening test.
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Screening for congenital adrenal hyperplasia
Screening for cardiac risk
Screening for diabetes
Screening for MASLD
Screening for obstructive sleep apnea
Screening for depression/anxiety
Screening for endometrial cancer
Medical management
Hormonal contraceptives: as per ACOG 2018 guidelines, initiate combination low-dose hormonal contraceptives, frequently used for the long term, as primary treatment of menstrual disorders.
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Insulin sensitizers
Ovulation induction
Statin therapy
Weight loss medications
Management of hirsutism
Nonpharmacologic interventions
Therapeutic procedures
Surgical interventions
Laparoscopic surgery: as per SOGC 2023 guidelines, consider performing laparoscopic ovarian drilling in patients with PCOS resistant to oral agents if gonadotropins are not accessible.
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Bariatric surgery
Specific circumstances
Pregnant patients: as per RCOG 2014 guidelines, consider obtaining screening for gestational diabetes in patients diagnosed with PCOS before pregnancy. Obtain screening at 24-28 weeks of gestation and refer to a specialist obstetric diabetic service if abnormalities are detected.
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Adolescent patients (diagnosis)
Adolescent patients (hyperandrogenemia)
Adolescent patients (oligoanovulation)
Adolescent patients (insulin resistance)
Patients with diabetes