The long-term health consequences of Polycystic Ovary Syndrome (PCOS) are outlined in new revised guidelines published today by the Royal College of Obstetricians and Gynaecologists (RCOG).
This Green-top Guideline provides information, based on clinical evidence, to assist clinicians who manage women with PCOS.
PCOS is a common disorder and can affect a woman’s menstrual cycle, fertility, hormones and aspects of her appearance. It can also affect long-term health. Many women with this condition are obese and have a higher prevalence of impaired glucose tolerance, type 2 diabetes and sleep apnoea.
PCOS should be diagnosed according to the Rotterdam Consensus Criteria, which suggests a broader definition. Under this criteria, PCOS is diagnosed when a woman has two out of three of the following: polycystic ovaries, lack of ovulation and signs of hyperandrogenism (excessive levels of androgens in the body).
The guideline states that healthcare professionals should inform women with PCOS of the possible long-term risks to health. All women with PCOS should also be assessed for cardiovascular disease risk by assessing individual risk factors (obesity, lack of physical activity, cigarette smoking, family history of type 2 diabetes, high cholesterol and high blood pressure) at the time of initial diagnosis, states the guideline.
Women are also at an increased risk of psychological and behavioural disorders, such as depression and anxiety, as well as reduced quality of life. Therefore, psychological issues should be considered in all women with PCOS. Depression and/or anxiety should be routinely screened for and further assessment and appropriate counselling should be offered by a qualified professional, states the guideline.
The guideline also covers reduction in risk factors and how changes to lifestyle can help manage the condition. It recommends that lifestyle changes, including diet, exercise and weight loss, should be initiated as the first line of treatment for women for improvement of long-term outcomes alongside pharmacological treatment if needed.
For morbidly obese women, bariatric surgery may be an option if standard weight loss strategies have failed, the guideline states. However, surgically induced weight loss must be balanced against the risks of surgery, which can include bowel obstruction, infection and nutritional abnormalities.
Furthermore, the guideline looks at cancer and PCOS. Women who have amenorrhoea, the absence of menstrual periods, are at a higher risk of endometrial hyperplasia, a thickening of the lining of the womb caused by overgrowth of cells, and later cancer. This risk can be largely circumvented by induction of regular (2-3 per year) withdrawal bleeds. Women who choose not to have such treatment or when a woman experiences abnormal uterine bleeding, they are advised to have regular transvaginal ultrasound to measure endometrial thickness. Any increase in endometrial thickness should lead to further investigation.
Dr Thozhukat Sathyapalan, Reader/Honorary Consultant Physician, Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School and co-author of the guideline said:
“PCOS is relatively common and affects around 20% of women. It is important that women adopt a healthy lifestyle to reduce the long-term health risks associated with the condition. This can involve eating a balanced diet and taking regular exercise. Women will be advised on how to manage their condition by their healthcare professional overseeing their care.”
Dr Manish Gupta, co-Chair of the RCOG Guidelines Committee said:
“This revised guideline provides the latest information on the management of PCOS. Women should be made aware of the long-term implications of their condition in a way that is tailored to their individual circumstances.
“PCOS can affect women psychologically and it is vital that they receive the right support for this. Many patients find great benefit from support groups which can help and healthcare professionals should provide sources of information.”
This is the third edition of this guideline, which was previously published under the same title in 2003 and 2007.
Verity is a UK charity for women whose lives are affected by Polycystic Ovary Syndrome (PCOS). More information about Verity can be found here.
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