PCOS Management Guidelines

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a common hormonal condition in women of reproductive age, typically beginning in adolescence and affecting the ovaries and other body systems. It manifests as a set of symptoms and affects 8-13% of women of reproductive age, with up to 70% undiagnosed globally (World Health Organization, 2023).

The causes of PCOS aren't clearly established, but patients usually show insulin resistance and hormonal imbalance. Genetics and potentially fetal androgen exposure are also hypothesized as other causes (Rasquin & Mayrin, 2022).

Signs and diagnosis

PCOS diagnosis relies on meeting at least two out of three diagnostic criteria: irregular or missed periods, signs of androgen excess or hyperandrogenism (such as excess facial or body hair, acne, or male-pattern baldness), and the presence of polycystic ovaries on ultrasound. Several signs of PCOS to look out for include (John Hopkins Medicine, 2019; National Institute of Child Health and Human Development, 2022; NHS, 2019):

• Menstrual irregularities which can be in the form of amenorrhea (no menstrual periods) or oligomenorrhea (frequently missed periods)
• Infertility
• Excess hair growth (hirsutism) on the face, chest, belly, or upper thighs
• Severe acne that is difficult to treat
• Obesity, weight gain, especially around the waist
• Oily skin
• Patches of dark, thickened skin (acanthosis nigricans)
• Ovarian abnormalities: enlarged ovaries with cysts

Early detection of this can aid in creating appropriate and effective management treatment plans for patients.

Guidelines for PCOS treatment and management

PCOS is a chronic condition with no cure, but effective management can mitigate symptoms and reduce the risk of severe health complications. Lifestyle modifications, medication, and regular check-ups reduce symptoms (Dason et al., 2024; Jean Hailes for Women's Health, 2023; Rasquin & Mayrin, 2022).

Healthy diet

Diet and nutrition matter. Advise patients to adopt a balanced diet rich in whole foods like fruits, vegetables, lean proteins, and whole grains. Emphasize the importance of low-glycemic-index foods to help stabilize blood sugar levels and improve insulin sensitivity. Recommend reducing the intake of processed foods and sugary snacks to minimize insulin resistance and inflammation.

Exercise

Encourage patients to engage in regular physical activity as a vital component of managing PCOS. Physical exercise helps regulate blood glucose levels, enhances insulin sensitivity, and supports weight management. At least 150 minutes of weekly exercise is recommended (Woodward et al., 2020).

Weight loss

This, along with the first two methods, falls under lifestyle modification. PCOS patients also have a risk for obesity, impaired glucose tolerance, and diabetes. Weight loss can significantly improve PCOS symptoms and hormonal balance, which can reduce symptoms such as irregular menstrual cycles and hirsutism. Monitoring body mass index (BMI) is essential in supporting patients in creating personalized, safe, and effective weight loss plans, emphasizing gradual and sustainable changes.

Medication

Medications play a key role in managing PCOS symptoms. Prescribe oral contraceptives to regulate menstrual cycles and lower androgen levels, and consider metformin to improve insulin sensitivity and glucose metabolism. For patients with hirsutism and acne, anti-androgen medications can be effective.

Regular monitoring

Regular monitoring is essential to manage PCOS and prevent long-term complications. Schedule periodic check-ups to monitor metabolic risk factors, such as blood glucose and lipid levels, and screen for comorbidities like diabetes and cardiovascular disease. Adjust treatment plans based on the patient's progress and emerging health needs.

How to use our PCOS Management Guidelines handout template

Management of polycystic ovary syndrome isn't foreign to you. However, we put together this PCOS Management Guidelines handout to assist you. To use this, here are the steps:

Step 1: Download the handout

Click on the link embedded in this guide to download the PCOS Management Guidelines handout. You can save it on your device or print a copy if you want a physical copy to be used or displayed in your clinic during consultations.

Step 2: Use it during consultations

Having a handy reference during patient consultations ensures patient education on PCOS assessment and management. It also serves as an avenue for focused discussions, and you can provide one to your clients so they can go back to it whenever needed.

Step 3: Add essential notes

We've added a section for additional notes if you want to add salient information or updates to the handout. This is also a perfect way to write special notes for your clients tailored to their condition.

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References

Dason, E. S., Koshkina, O., Chan, C., & Sobel, M. (2024). Diagnosis and management of polycystic ovarian syndrome. CMAJ, 196(3), E85–E94. https://doi.org/10.1503/cmaj.231251

Jean Hailes for Women's Health. (2023, May 29). Management of PCOS. https://www.jeanhailes.org.au/health-a-z/pcos/management-treatment

John Hopkins Medicine. (2019). Polycystic ovary syndrome (PCOS). https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos

National Institute of Child Health and Human Development. (2022, September 29). What are the symptoms of PCOS?https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/symptoms

NHS. (2019). Symptoms - Polycystic ovary syndrome. https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/symptoms/

Rasquin, L., & Mayrin, J. V. (2022). Polycystic ovarian disease. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459251/

Woodward, A., Klonizakis, M., & Broom, D. (2020). Exercise and polycystic ovary syndrome. Physical Exercise for Human Health, 1228, 123–136. https://doi.org/10.1007/978-981-15-1792-1_8

World Health Organization. (2023, June 28). Polycystic ovary syndrome. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome