New PCOS Guidelines #89

What is new?

Hello,

We are officially into September WOW! It is also PCOS Awareness month 🎉.

A reminder our PCOS Genetics programme is starting at the of the month. If you are ready to figure out your PCOS this autumn, join here.

A few weeks ago, we discussed AMH as a potential diagnostic tool for PCOS.

This came from the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome, published last year.

The Australian Government primarily funded this effort via the National Health Medical Research Council, so we have them to thank. They gathered specialist doctors, organisations, patients and research representatives.

The guidelines recognise that patients are highly dissatisfied with the diagnosis and care process. They also recognise that healthcare professionals need significant education improvements on the latest evidence-based solutions.

The top guideline recommendations

1. Mental Health

Anxiety and Depression are significantly increased and should be screened for in all women with PCOS.

I am glad that this was added, as mental health is something that is often overlooked. Unfortunately, we know that mental health issues may arise more frequently for us, so being asked and feeling taken care of will be a great start.

In addition, they mention medical professionals to pay attention to eating disorders (my commentary: which might have been caused by this push for women with PCOS to lose weight at all times), body image issues and low quality of life. Excessive testosterone with its acne and excessive hair/loss of hair symptoms cause a lot of women to hate their bodies.

2. A life long plan

A lifelong plan is recommended, including a focus on a healthy lifestyle, prevention of weight gain, optimization of fertility, and treatment of the different symptoms. Once diagnosed, healthcare professionals need to address reproductive, metabolic, cardiovascular, dermatological, sleep, and physiological features.

Whilst this sounds great in theory, I can’t help but think of our collapsing healthcare systems worldwide. They are not equipped with the time and set-up to take care of this condition well. No healthcare professional, in their 10-20 min consultation with us, will have time to build a lifelong plan and address all of these things. This is when the responsibility falls on the patient who ends up on a random forum that tells them to cut all carbs and walk 20,000 steps a day. It’s not a great set-up, but it gives rise to services like ours at The PCOS Clinic to close this gap. However, I am also aware that this is not fair for everyone as we can’t all afford private care.

3. Weight

Supported healthy lifestyle remains vital for the management of PCOS. There is no specific diet and physical activity regime that is superior to others for PCOS.

This is an important one. I am so glad we are specifically pointing out that different diet and workout routines work for different people, and I am embracing my philosophy of getting to know what works for you. However, it didn’t stop an endocrinologist from suggesting intermittent fasting…as that’s what she heard works.

In addition, they mention weight bias and stigma should be minimised, and healthcare professionals should seek permission to weigh women. I have yet to be asked for permission, so I look forward to when this will be implemented.

3. Medication

The combined oral pill remained the first pharmacological treatment. Metformin is recommended primarily for metabolic features. It is mentioned here that it has greater efficacy than Inositol, which offers limited clinical benefits for PCOS.

I was a bit shocked to read this, as multiple systemic reviews proved how Inositol helps PCOS, in some cases even being better than Metformin. I have only found one systemic review that showed that it was inferior, and that seems to have been published for these guidelines gathering. I remain a bit sceptical of this specific point.

4. Infertility

Letrozole is the first line of pharmacological therapy, along with Clomiphene and metformin. Ovarian surgery and gonadotropins are seen as second-line therapy. Lastly, IVF is seen as a last resort.

5. Diagnosis

The guidelines have added AMH as an alternative diagnostics tool if ultrasound is impossible. You can read all about it in my previous article here.

Overall, the quality of evidence for the management of PCOS has been declared low to moderate. This means we need much more research and clarity on this condition. We knew this, but I am glad it’s being recognised at the official level.

Overall, it reinforces some of what we know and raises awareness of the complexity of managing this condition and the gaps that exist.

See you next week,

Francesca

Our Genetics-based PCOS program is open. We are only accepting seven people into the programme, and spaces are filling up. If you are ready to understand your PCOS in depth and have a personalised management plan, join us here.

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1. International, P. (2023). International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome 2023.

Disclaimer: We are all unique in our ways, so this information is for educational purposes only. In my communications, I summarise research data and bring my experience. This shouldn’t be viewed as medical advice at any point. Please consult your healthcare provider further about your health needs.