The Journal of Clinical Endocrinology & Metabolism (JECM)Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

Updated PCOS Guidelines Refine Diagnostic Criteria and Emphasize Multifaceted Care Approach

The 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (PCOS) provides an updated, comprehensive framework for clinicians. This guideline, based on extensive evidence synthesis and multidisciplinary expertise, offers 254 recommendations and practice points to improve consistency in care and health outcomes for individuals with PCOS. The update addresses key areas including refined diagnostic criteria, recognition of broader PCOS features, and emphasis on evidence-based therapies.

Key Points:

• The guideline update involved 39 professional and consumer organizations covering 71 countries.
• Evidence quality has improved but remains generally low to moderate.
• Key updates include:
  • Refined individual diagnostic criteria and a simplified diagnostic algorithm
  • Inclusion of anti-Müllerian hormone (AMH) levels as an alternative to ultrasound in adults
  • Strengthened recognition of metabolic risk factors, cardiovascular disease, and sleep apnea
  • Acknowledgment of high prevalence of psychological features
  • Emphasis on high-risk status for adverse pregnancy outcomes
• The guideline stresses the need for:
  • Greater healthcare professional education
  • Evidence-based patient information
  • Improved models of care and shared decision making
  • Increased research in PCOS
• Recommendations maintain focus on:
  • Healthy lifestyle
  • Emotional wellbeing and quality of life
  • Awareness and consideration of weight stigma
• The guideline emphasizes evidence-based medical therapy and more cost-effective, safer fertility management.
• The update includes 77 evidence-based recommendations, 54 consensus recommendations, and 123 practice points.
• Funding was primarily provided by the Australian Government via the National Health Medical Research Council (NHMRC).
• The guideline was independently reviewed for methodological rigor and approved by the Australian Government NHMRC.
• A comprehensive dissemination and translation program supports the guideline implementation.

Polycystic ovary syndrome (PCOS) affects an estimated 8–13% of reproductive-aged women, and up to 70% of affected women remain undiagnosed worldwide. (OU Health)

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