O-229 Long term features of PCOS and Medical treatment
Authors: Piltonen T 
Published: June 2023

Abstract
Objective: To develop and translate comprehensive evidence-based guidelines for diagnosis, assessment and treatment, to improve the lives of those with polycystic ovary syndrome (PCOS) worldwide.
Participants: Health professional and consumer/ patients informed priorities. International society-nominated panels included consumers, and experts in reproductive endocrinology, obstetrics, gynaecology, paediatrics, endocrinology, primary care, psychology, dietetics, exercise physiology, sleep, bariatric/ metabolic surgery, public health, other co-opted experts, evidence synthesis and translation.
Evidence: Best practice guideline development involved extensive evidence synthesis and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework covered evidence quality, feasibility, acceptability, cost, implementation and recommendation strength.
Process: Governance included international advisory and project, guideline development, consumer and translation committees. The Centre for Research Excellence in Women’s Health in Reproductive Life, funded by the Australian National Health and Medical Research Council (NHMRC), and led by Monash University, partnered with the American Society for Reproductive Medicine, Endocrine Society, European Endocrine Society and European Society of Human Reproduction and Embryology. Another 30 collaborating organisations engaged. Overall 52 systematic and three narrative reviews, informed international guideline groups, generating evidence-based and consensus recommendations and practice points for 55 clinical questions. Collaborating/ partnering organisations and NHMRC methodological experts led peer review.
Recommendations: After diagnosing PCOS, assessment and management should include reproductive, metabolic, cardiovascular, dermatologic, sleep and psychological features. A reproductive health plan is recommended including diagnosis and support in adolescence, lifelong healthy lifestyle / prevention of weight gain, fertility optimisation, preconception risk mitigation and recognition of PCOS as a high-risk pregnancy condition requiring identification, screening, monitoring and management. Metabolic risk factors, diabetes, cardiovascular disease and sleep disorders are increased in PCOS, with screening and management recommended. Increased premenopausal endometrial cancer risk should be recognised. Depressive and anxiety symptoms are significantly increased, with universal screening recommended. Greater awareness of psychological features including eating disorders, body image and quality of life impacts is recommended. Life-style intervention is the first line treatment for PCOS, but in many cases medication is also needed. Combined oral contraceptive pills are first line pharmacological treatment for menstrual irregularity and hyperandrogenism, with no specific recommended preparation, and a preference for lower dose and less side-effects. Metformin is recommended primarily for metabolic features noting greater efficacy than inositol, which offers more limited clinical benefits. Metformin is not routinely recommended for use in pregnancy. Laser therapy is effective and recommended for hair reduction in identified subgroups, whilst anti-androgens have more limited recommendations. Anti-obesity agents and bariatric/ metabolic surgery may be considered based on general population guidelines, balancing benefits and side effects. Overall, evidence was low to moderate quality. Based on high prevalence and significant health impact, greater priority, education, funding and research is strongly recommended.