TY - JOUR
T1 - Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome
AU - Teede, Helena J
AU - Tay, Chau Thien
AU - Laven, Joop
AU - Dokras, Anuja
AU - Moran, Lisa J
AU - Piltonen, Terhi T
AU - Costello, Michael F
AU - Boivin, Jacky
AU - Redman, Leanne M
AU - Boyle, Jacqueline A
AU - Norman, Robert J
AU - Mousa, Aya
AU - Joham, Anju E
AU - International PCOS Network
AU - Arlt, Wiebke
AU - Azziz, Ricardo
AU - Balen, Adam
AU - Bedson, Lisa
AU - Berry, Lorna
AU - Brennan, Leah
AU - Brown, Wendy
AU - Burgert, Tania
AU - Busby, Maureen
AU - Ee, Carolyn
AU - Garad, Rhonda M
AU - Gibson-Helm, Melanie
AU - Harrison, Cheryce
AU - Hart, Roger
AU - Hopkins, Kim
AU - Hirschberg, Angelica Lindén
AU - Ho, Tuong
AU - Hoeger, Kathleen
AU - Jordan, Cailin
AU - Legro, Richard S
AU - Li, Rong
AU - Lujan, Marla
AU - Ma, Ronald
AU - Mansfield, Darren
AU - Marsh, Kate
AU - Mocanu, Edgar
AU - Mol, Ben
AU - Mormon, Rachel
AU - Norman, Robert
AU - Oberfield, Sharon
AU - Patel, Malika
AU - Pattuwage, Loyal
AU - Peña, Alexia
AU - Redman, Leanne
AU - Rombauts, Luk
AU - Romualdi, Daniela
AU - Shah, Duru
AU - Spritzer, Poli Mara
AU - Stener-Victorin, Elisabet
AU - Tehrani, Fahimeh Ramezani
AU - Thangaratinam, Shakila
AU - Thondan, Mala
AU - Vanky, Eszter
AU - Wijeyaratne, Chandrika
AU - Witchel, Selma
AU - Yang, Dongzi
AU - Yildiz, Bulent
AU - Alesi, Simon
AU - Alur-Gupta, Snigdha
AU - Avery, Jodie
AU - Khomami, Mahnaz Bahri
AU - Benham, Jamie
AU - Bidstrup, Hugh
AU - Chua, Su Jen
AU - Cooney, Laura
AU - Coster, Thisara
AU - Fitz, Victoria
AU - Flanagan, Madeline
AU - Forslund, Maria
AU - Jiskoot, Geranne
AU - Kazemi, Maryam
AU - Kempegowda, Punith
AU - Louwers, Yvonne
AU - Melin, Johanna
AU - Melson, Eka
AU - Mengistu, Yitayeh Belsti
AU - Naderpoor, Negar
AU - Neven, Adriana
AU - Pastoor, Hester
AU - Rocha, Thais
AU - Sabag, Angelo
AU - Subramanian, Anuradhaa
AU - Tan, Katrina
N1 - This article has been co-published with permission in Fertility and Sterility, Human Reproduction, European Journal of Endocrinology, and The Journal of Clinical Endocrinology and Metabolism.
PY - 2023/10
Y1 - 2023/10
N2 - STUDY QUESTION: What is the recommended assessment and management of those with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? SUMMARY ANSWER: International evidence-based guidelines address prioritized questions and outcomes and include 254 recommendations and practice points, to promote consistent, evidence-based care and improve the experience and health outcomes in PCOS. WHAT IS KNOWN ALREADY: The 2018 International PCOS Guideline was independently evaluated as high quality and integrated multidisciplinary and consumer perspectives from six continents; it is now used in 196 countries and is widely cited. It was based on best available, but generally very low to low quality, evidence. It applied robust methodological processes and addressed shared priorities. The guideline transitioned from consensus based to evidence-based diagnostic criteria and enhanced accuracy of diagnosis, whilst promoting consistency of care. However, diagnosis is still delayed, the needs of those with PCOS are not being adequately met, evidence quality was low and evidence-practice gaps persist. STUDY DESIGN, SIZE, DURATION: The 2023 International Evidence-based Guideline update reengaged the 2018 network across professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Extensive evidence synthesis was completed. Appraisal of Guidelines for Research and Evaluation-II (AGREEII)-compliant processes were followed. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength and diversity and inclusion were considered throughout. PARTICIPANTS/MATERIALS, SETTING, METHODS: This summary should be read in conjunction with the full Guideline for detailed participants and methods. Governance included a six-continent international advisory and management committee, five guideline development groups, and paediatric, consumer, and translation committees. Extensive consumer engagement and guideline experts informed the update scope and priorities. Engaged international society-nominated panels included paediatrics, endocrinology, gynaecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, obesity care, public health and other experts, alongside consumers, project management, evidence synthesis, statisticians and translation experts. Thirty-nine professional and consumer organizations covering 71 countries engaged in the process. Twenty meetings and five face-to-face forums over 12 months addressed 58 prioritized clinical questions involving 52 systematic and 3 narrative reviews. Evidence-based recommendations were developed and approved via consensus across five guideline panels, modified based on international feedback and peer review, independently reviewed for methodological rigour, and approved by the Australian Government National Health and Medical Research Council (NHMRC). MAIN RESULTS AND THE ROLE OF CHANCE: The evidence in the assessment and management of PCOS has generally improved in the past five years, but remains of low to moderate quality. The technical evidence report and analyses (∼6000 pages) underpins 77 evidence-based and 54 consensus recommendations, with 123 practice points. Key updates include: i) further refinement of individual diagnostic criteria, a simplified diagnostic algorithm and inclusion of anti-Müllerian hormone (AMH) levels as an alternative to ultrasound in adults only; ii) strengthening recognition of broader features of PCOS including metabolic risk factors, cardiovascular disease, sleep apnea, very high prevalence of psychological features, and high risk status for adverse outcomes during pregnancy; iii) emphasizing the poorly recognized, diverse burden of disease and the need for greater healthcare professional education, evidence-based patient information, improved models of care and shared decision making to improve patient experience, alongside greater research; iv) maintained emphasis on healthy lifestyle, emotional wellbeing and quality of life, with awareness and consideration of weight stigma; and v) emphasizing evidence-based medical therapy and cheaper and safer fertility management. LIMITATIONS, REASONS FOR CAUTION: Overall, recommendations are strengthened and evidence is improved, but remain generally low to moderate quality. Significantly greater research is now needed in this neglected, yet common condition. Regional health system variation was considered and acknowledged, with a further process for guideline and translation resource adaptation provided. WIDER IMPLICATIONS OF THE FINDINGS: The 2023 International Guideline for the Assessment and Management of PCOS provides clinicians and patients with clear advice on best practice, based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation programme supports the Guideline with an integrated evaluation program.
AB - STUDY QUESTION: What is the recommended assessment and management of those with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? SUMMARY ANSWER: International evidence-based guidelines address prioritized questions and outcomes and include 254 recommendations and practice points, to promote consistent, evidence-based care and improve the experience and health outcomes in PCOS. WHAT IS KNOWN ALREADY: The 2018 International PCOS Guideline was independently evaluated as high quality and integrated multidisciplinary and consumer perspectives from six continents; it is now used in 196 countries and is widely cited. It was based on best available, but generally very low to low quality, evidence. It applied robust methodological processes and addressed shared priorities. The guideline transitioned from consensus based to evidence-based diagnostic criteria and enhanced accuracy of diagnosis, whilst promoting consistency of care. However, diagnosis is still delayed, the needs of those with PCOS are not being adequately met, evidence quality was low and evidence-practice gaps persist. STUDY DESIGN, SIZE, DURATION: The 2023 International Evidence-based Guideline update reengaged the 2018 network across professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Extensive evidence synthesis was completed. Appraisal of Guidelines for Research and Evaluation-II (AGREEII)-compliant processes were followed. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength and diversity and inclusion were considered throughout. PARTICIPANTS/MATERIALS, SETTING, METHODS: This summary should be read in conjunction with the full Guideline for detailed participants and methods. Governance included a six-continent international advisory and management committee, five guideline development groups, and paediatric, consumer, and translation committees. Extensive consumer engagement and guideline experts informed the update scope and priorities. Engaged international society-nominated panels included paediatrics, endocrinology, gynaecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, obesity care, public health and other experts, alongside consumers, project management, evidence synthesis, statisticians and translation experts. Thirty-nine professional and consumer organizations covering 71 countries engaged in the process. Twenty meetings and five face-to-face forums over 12 months addressed 58 prioritized clinical questions involving 52 systematic and 3 narrative reviews. Evidence-based recommendations were developed and approved via consensus across five guideline panels, modified based on international feedback and peer review, independently reviewed for methodological rigour, and approved by the Australian Government National Health and Medical Research Council (NHMRC). MAIN RESULTS AND THE ROLE OF CHANCE: The evidence in the assessment and management of PCOS has generally improved in the past five years, but remains of low to moderate quality. The technical evidence report and analyses (∼6000 pages) underpins 77 evidence-based and 54 consensus recommendations, with 123 practice points. Key updates include: i) further refinement of individual diagnostic criteria, a simplified diagnostic algorithm and inclusion of anti-Müllerian hormone (AMH) levels as an alternative to ultrasound in adults only; ii) strengthening recognition of broader features of PCOS including metabolic risk factors, cardiovascular disease, sleep apnea, very high prevalence of psychological features, and high risk status for adverse outcomes during pregnancy; iii) emphasizing the poorly recognized, diverse burden of disease and the need for greater healthcare professional education, evidence-based patient information, improved models of care and shared decision making to improve patient experience, alongside greater research; iv) maintained emphasis on healthy lifestyle, emotional wellbeing and quality of life, with awareness and consideration of weight stigma; and v) emphasizing evidence-based medical therapy and cheaper and safer fertility management. LIMITATIONS, REASONS FOR CAUTION: Overall, recommendations are strengthened and evidence is improved, but remain generally low to moderate quality. Significantly greater research is now needed in this neglected, yet common condition. Regional health system variation was considered and acknowledged, with a further process for guideline and translation resource adaptation provided. WIDER IMPLICATIONS OF THE FINDINGS: The 2023 International Guideline for the Assessment and Management of PCOS provides clinicians and patients with clear advice on best practice, based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation programme supports the Guideline with an integrated evaluation program.
KW - assessment
KW - evidence-based
KW - GRADE
KW - guideline
KW - management
KW - Polycystic ovary syndrome
UR - http://www.scopus.com/inward/record.url?scp=85169816782&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1171592
U2 - 10.1016/j.fertnstert.2023.07.025
DO - 10.1016/j.fertnstert.2023.07.025
M3 - Article
AN - SCOPUS:85169816782
SN - 0015-0282
VL - 120
SP - 767
EP - 793
JO - Fertility and Sterility
JF - Fertility and Sterility
IS - 4
ER -