Evidence-based Methodology Workshop on Polycystic Ovary Syndrome (December 3-5, 2012)
A 2 ½ day workshop was held December 3-5, 2012, in order to bring together experts to discuss polycystic ovary syndrome (PCOS). The panel offered the following recommendations.
PCOS Name Is a Distraction
Many advances have been made since PCOS was first described by Irving F. Stein, Sr. and Michael L. Leventhal, and the emphasis placed on polycystic ovarian morphology leads to confusion since its presence is neither needed nor sufficient in order to diagnose PCOS.
A new name is needed that more broadly encompasses and represents this complex syndrome.
Rotterdam Diagnostic Criteria Should Be Used
The Rotterdam criteria were developed in 2003. For diagnosis of PCOS, 2 of the following 3 criteria must be met:
- oligo- and/or anovulation
- clinical and/or biomechanical signs of hyperandrogenism
- polycystic ovaries
The panel recommends the use of the Rotterdam criteria. They also recommend that the following phenotypes be used:
- androgen excess + ovulatory dysfunction
- androgen excess + polycystic ovarian morphology
- ovulatory dysfunction + polycystic ovarian morphology
- androgen excess + ovulatory dysfunction + polycystic ovarian morphology
Methods and Criteria for Assessing PCOS Must Be Improved
For androgen excess, it is important to develop an accurate assay for androgen levels. Normal ranges for various ethnic groups and age groups must be defined; this will help with defining the diagnostic criteria for androgen excess.
For ovulatory dysfunction, it is important to better define the diagnostic criteria for oligomenorrhea, amenorrhea, and anovulation. Normal ranges should be established for age and ethnic groups.
For polycystic ovarian morphology, it is important to develop methods that accurately define it. As with ovulatory dysfunction, normal ranges for age and ethnic groups should be established.
Get Patients Involved
The Australian task force involved patients in developing guidelines, and that is a good model. Primary care providers and multidisciplinary teams should also be engaged.
Clinical Studies Needed
Much research is needed in PCOS, including studies to:
- examine the genetic or epigenetic causes of PCOS: These should be carefully phenotyped.
- determine the prevalence of abnormal glucose tolerance in women who want to conceive: Does treatment for abnormal glucose before conception affect maternal-fetal outcomes?
- figure out how PCOS alters ovarian, hypothalamic-pituitary-adrenal, and metabolic function: This translational research could lead to better treatment.
- look at the association with cardiovascular and diabetic complications: Are these risks increased in certain phenotypes? Can treating the metabolic abnormalities reduce these risks?
- examine if PCOS is related to endometrial, breast, and ovarian cancers: If it is, how can we improve prevention, detection, and treatment?
- determine the best treatments for the most common symptoms: Treatments for the most common patient complaints (hirsutism and obesity) should also be studied.
- determine the best practices for achieving pregnancy: What therapies are the most efficacious?
Multidisciplinary Programs Are Needed
For women currently living with PCOS, multidisciplinary programs to promote public understanding and awareness may help.
Commentary by J. Michael Gonzalez-Campoy MD, PhD, FACE
Read Dr. Gonzalez-Campoy's insight into these recommendations in his EndoScan introduction