In addition to these evidence-based recommendations, the guideline development group also identifies points of best clinical practice in the original guideline document.
Levels of evidence (Ia-IV) and grading of recommendations (A-C) are defined at the end of the "Major Recommendations" field.
Diagnosis of Polycystic Ovary Syndrome (PCOS)
C - Young women diagnosed with PCOS should be informed of the possible long-term risks to health that are associated with their condition. They should be advised regarding weight and exercise. [Evidence level III]
Metabolic Consequences of PCOS
PCOS and Risk of Type II Diabetes
C - Patients presenting with PCOS, particularly if they are obese, should be offered measurement of fasting blood glucose and urinalysis for glycosuria. Abnormal results should be investigated by a glucose tolerance test. Such patients are at increased risk of developing type II diabetes. [Evidence level IIb]
PCOS and Cardiovascular Risk
C - Measurement of fasting cholesterol, lipids, and triglycerides should be offered to patients with PCOS, since early detection of abnormal levels might encourage improvement in diet and exercise. [Evidence level III]
PCOS and Pregnancy
B - Women who have been diagnosed as having PCOS before pregnancy (e.g., those requiring ovulation induction for conception) should be screened for gestational diabetes in early pregnancy, with referral to a specialised obstetric diabetic service if abnormalities are detected. [Evidence level IIb]
PCOS and Cancer
B - Oligo- and amenorrhoeic women with PCOS may develop endometrial hyperplasia and later carcinoma. It is good practice to recommend treatment with progestogens to induce a withdrawal bleed at least every three to four months. [Evidence level IIa]
Strategies for Reduction of Risk
Exercise and Weight Control
The impact of exercise and reduction in body mass by hypocaloric dieting on ovarian function in PCOS is well characterized. Adoption of simple methods for reduction of body fat and improvement in physical fitness will result in resumption of ovulation and increase in fertility in a high proportion of obese PCOS women.
Drug Therapy
B - Insulin-sensitising agents have not been licensed in the United Kingdom (UK) for use in nondiabetic patients. Nevertheless, a body of evidence has accumulated demonstrating both their safety and, in some studies, efficacy in the management of short-term complications of PCOS, particularly anovulation. Long-term use of insulin-sensitising agents for avoidance of metabolic complications of PCOS cannot as yet be recommended. [Evidence level IV]
Screening Young PCOS Patients for Long-Term Health Risk
C - No clear consensus has yet emerged concerning regular screening of women with PCOS for later development of diabetes and dyslipidemia, (Ehrmann et al. 1999; Kelly et al., 2000) but obese women with a strong family history of cardiac disease or diabetes should be assessed regularly in a general practice or hospital outpatient setting. Local protocols should be developed and adapted as new evidence emerges. [Evidence level IV]
Definitions:
Grading of Recommendations
Grade A - Requires at least one randomised controlled trial as part of a body of literature of overall good quality and consistency addressing the specific recommendation (evidence levels Ia, Ib)
Grade B - Requires the availability of well-conducted clinical studies but no randomised clinical trials on the topic of recommendations (evidence levels IIa, IIb, III)
Grade C - Requires evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities. Indicates an absence of directly applicable clinical studies of good quality (evidence level IV)
Levels of Evidence
Ia: Evidence obtained from meta-analysis of randomised controlled trials
Ib: Evidence obtained from at least one randomised controlled trial
IIa: Evidence obtained from at least one well-designed controlled study without randomisation
IIb: Evidence obtained from at least one other type of well-designed quasi-experimental study
III: Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies, and case studies
IV: Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities
