Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

International PCOS Network

doi:10.5694/mja18.00656

Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

International PCOS Network

Research output: Contribution to journal › Article › peer-review

80 Citations (Scopus)

Abstract

Introduction: We have developed the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS), with an integrated translation program incorporating resources for health professionals and consumers. The development process involved an extensive Australian-led international and multidisciplinary collaboration of health professionals and consumers over 2 years. The guideline is approved by the National Health and Medical Research Council and aims to support both health professionals and women with PCOS in improving care, health outcomes and quality of life. A robust evaluation process will enable practice benchmarking and feedback to further inform evidence-based practice. We propose that this methodology could be used in developing and implementing guidelines for other women's health conditions and beyond. Main recommendations: The recommendations cover the following broad areas: diagnosis, screening and risk assessment depending on life stage; emotional wellbeing; healthy lifestyle; pharmacological treatment for non-fertility indications; and assessment and treatment of infertility. Changes in management as a result of this guideline: •Diagnosis:▪when the combination of hyperandrogenism and ovulatory dysfunction is present, ultrasound examination of the ovaries is not necessary for diagnosis of PCOS in adult women;▪requires the combination of hyperandrogenism and ovulatory dysfunction in young women within 8 years of menarche, with ultrasound examination of the ovaries not recommended, owing to the overlap with normal ovarian physiology; and▪adolescents with some clinical features of PCOS, but without a clear diagnosis, should be regarded as “at risk” and receive follow-up assessment.•Screening for metabolic complications has been refined and incorporates both PCOS status and additional metabolic risk factors.•Treatment of infertility: letrozole is now first line treatment for infertility as it improves live birth rates while reducing multiple pregnancies compared with clomiphene citrate.

Original language	English
Pages (from-to)	S3-S8
Number of pages	6
Journal	Medical Journal of Australia
Volume	209
Issue number	S7
DOIs	https://doi.org/10.5694/mja18.00656
Publication status	Published - 1 Oct 2018

Bibliographical note

Funding: The guideline and translation program was primarily funded by the NHMRC Centre for Research Excellence in PCOS grant (APP1078444) and partnership grant (APP1133084). This funding was supported by a partnership with the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine. Translation costs were supported by the NHMRC Centre for Research Excellence and partnership grant. Jean Hailes for Women’s Health funded the cost of this MJA supplement.

Funding

Process: Governance included an international advisory board from six continents, a project board, five guideline development groups with 63 members, consumer and translation committees. The Australian Centre for Research Excellence in PCOS, funded by the National Health and Medical Research Council (NHMRC), partnered with European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine. Thirty seven organisations across 71 countries collaborated with 23 face to face international meetings over 15 months. Sixty prioritised clinical questions involved 40 systematic and 20 narrative reviews, generating 166 recommendations and practice points. Convened Committees from partner and collaborating organisations provided peer review and the guideline was approved by the NHMRC. Specifically, our funding, partner, collaborator and engaged organisations include: • The NHMRC through the funded Centre for Research Excellence in Polycystic Ovary Syndrome and the members of this Centre who coordinated this international guideline effort. • Our partner organisations which co-funded the guideline: the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology. • Our collaborating and engaged societies and consumer groups: Androgen Excess and Polycystic Ovary Syndrome Society; American Pediatric Endocrine Society; Asia Pacific Paediatric Endocrine Society; Asia Pacific Initiative on Reproduction; Australasian Paediatric Endocrine Group; Australian Diabetes Society; British Fertility Society; Canadian Society of Endocrinology and Metabolism; Dietitians Association Australia; Endocrine Society (US); Endocrine Society Australia; European Society of Endocrinology; European Society for Paediatric Endocrinology; Exercise and Sports Science Australia; Fertility Society Australia; International Society of Endocrinology; International Federation of Fertility Societies; International Federation of Gynaecology and Obstetrics; Italian Society of Gynaecology and Obstetrics; Japanese Society for Paediatric Endocrinology; Latin American Society for Paediatric Endocrinology; Nordic Federation of Societies of Obstetrics and Gynaecology; PCOS Challenge; PCOS Society of India; Paediatric Endocrine Society; Polycystic Ovary Association Australia; Royal Australasian College of Physicians; Royal Australian College of General Practitioners; Royal Australian and New Zealand College of Obstetricians and Gynaecologists; Royal College of Obstetricians and Gynaecologists (UK); South African Society of Gynaecology and Obstetrics; Verity UK; Victorian Assisted Reproductive Technology Association (VARTA). • Our Australian translation partners: Jean Hailes for Women’s Health and VARTA. Funding: The guideline and translation program was primarily funded by the NHMRC Centre for Research Excellence in PCOS grant (APP1078444) and partnership grant (APP1133084). This funding was supported by a partnership with the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine. Translation costs were supported by the NHMRC Centre for Research Excellence and partnership grant. Jean Hailes for Women’s Health funded the cost of this MJA supplement. Competing interests: Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of conflicts declared across the guideline development groups are available at https://www-monash-edu.ezproxy.lib.monash.edu.au/medicine/sphpm/mchri/pcos/ guideline in the register of disclosures of interest. Michael Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Joop Laven has received grants from Ferring Pharmaceuticals and Euroscreen, and personal fees from Ferring Pharmaceuticals, Euroscreen, Danone and Titus Health Care. Robert Norman is a minor shareholder interest in an IVF unit. The remaining authors have no conflicts of interest to declare. Provenance: Commissioned; externally peer reviewed. n

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Endocrine system diseases
General medicine
Womenˈs health

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Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. / International PCOS Network.
In: Medical Journal of Australia, Vol. 209, No. S7, 01.10.2018, p. S3-S8.

Research output: Contribution to journal › Article › peer-review

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abstract = "Introduction: We have developed the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS), with an integrated translation program incorporating resources for health professionals and consumers. The development process involved an extensive Australian-led international and multidisciplinary collaboration of health professionals and consumers over 2 years. The guideline is approved by the National Health and Medical Research Council and aims to support both health professionals and women with PCOS in improving care, health outcomes and quality of life. A robust evaluation process will enable practice benchmarking and feedback to further inform evidence-based practice. We propose that this methodology could be used in developing and implementing guidelines for other women's health conditions and beyond. Main recommendations: The recommendations cover the following broad areas: diagnosis, screening and risk assessment depending on life stage; emotional wellbeing; healthy lifestyle; pharmacological treatment for non-fertility indications; and assessment and treatment of infertility. Changes in management as a result of this guideline: •Diagnosis:▪when the combination of hyperandrogenism and ovulatory dysfunction is present, ultrasound examination of the ovaries is not necessary for diagnosis of PCOS in adult women;▪requires the combination of hyperandrogenism and ovulatory dysfunction in young women within 8 years of menarche, with ultrasound examination of the ovaries not recommended, owing to the overlap with normal ovarian physiology; and▪adolescents with some clinical features of PCOS, but without a clear diagnosis, should be regarded as “at risk” and receive follow-up assessment.•Screening for metabolic complications has been refined and incorporates both PCOS status and additional metabolic risk factors.•Treatment of infertility: letrozole is now first line treatment for infertility as it improves live birth rates while reducing multiple pregnancies compared with clomiphene citrate.",

keywords = "Endocrine system diseases, General medicine, Womenˈs health",

author = "Teede, \{Helena J.\} and Misso, \{Marie L.\} and Boyle, \{Jacqueline A.\} and Garad, \{Rhonda M.\} and Veryan McAllister and Linda Downes and Melanie Gibson-Helm and Hart, \{Roger J.\} and Luk Rombauts and Lisa Moran and Anuja Dokras and Joop Laven and Terhi Piltonen and Rodgers, \{Raymond J.\} and Mala Thondan and Costello, \{Michael F.\} and Norman, \{Robert J.\} and Estifanos Baye and Leah Brennan and Cheryce Harrison and Samantha Hutchison and Anju Joham and Louise Johnson and Cailin Jordan and Jayashri Kulkarni and Darren Mansfield and Kate Marsh and Mol, \{Ben W.\} and Alexia Pe{\~n}a and Jane Speight and Nigel Stepto and Tassone, \{Eliza C.\} and Angela Wan and Jane Woolcock and \{International PCOS Network\}",

note = "Funding: The guideline and translation program was primarily funded by the NHMRC Centre for Research Excellence in PCOS grant (APP1078444) and partnership grant (APP1133084). This funding was supported by a partnership with the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine. Translation costs were supported by the NHMRC Centre for Research Excellence and partnership grant. Jean Hailes for Women{\textquoteright}s Health funded the cost of this MJA supplement.",

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AU - Misso, Marie L.

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AU - Garad, Rhonda M.

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AU - Downes, Linda

AU - Gibson-Helm, Melanie

AU - Hart, Roger J.

AU - Rombauts, Luk

AU - Moran, Lisa

AU - Dokras, Anuja

AU - Laven, Joop

AU - Piltonen, Terhi

AU - Rodgers, Raymond J.

AU - Thondan, Mala

AU - Costello, Michael F.

AU - Norman, Robert J.

AU - Baye, Estifanos

AU - Brennan, Leah

AU - Harrison, Cheryce

AU - Hutchison, Samantha

AU - Joham, Anju

AU - Johnson, Louise

AU - Jordan, Cailin

AU - Kulkarni, Jayashri

AU - Mansfield, Darren

AU - Marsh, Kate

AU - Mol, Ben W.

AU - Peña, Alexia

AU - Speight, Jane

AU - Stepto, Nigel

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AU - Woolcock, Jane

AU - International PCOS Network

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N2 - Introduction: We have developed the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS), with an integrated translation program incorporating resources for health professionals and consumers. The development process involved an extensive Australian-led international and multidisciplinary collaboration of health professionals and consumers over 2 years. The guideline is approved by the National Health and Medical Research Council and aims to support both health professionals and women with PCOS in improving care, health outcomes and quality of life. A robust evaluation process will enable practice benchmarking and feedback to further inform evidence-based practice. We propose that this methodology could be used in developing and implementing guidelines for other women's health conditions and beyond. Main recommendations: The recommendations cover the following broad areas: diagnosis, screening and risk assessment depending on life stage; emotional wellbeing; healthy lifestyle; pharmacological treatment for non-fertility indications; and assessment and treatment of infertility. Changes in management as a result of this guideline: •Diagnosis:▪when the combination of hyperandrogenism and ovulatory dysfunction is present, ultrasound examination of the ovaries is not necessary for diagnosis of PCOS in adult women;▪requires the combination of hyperandrogenism and ovulatory dysfunction in young women within 8 years of menarche, with ultrasound examination of the ovaries not recommended, owing to the overlap with normal ovarian physiology; and▪adolescents with some clinical features of PCOS, but without a clear diagnosis, should be regarded as “at risk” and receive follow-up assessment.•Screening for metabolic complications has been refined and incorporates both PCOS status and additional metabolic risk factors.•Treatment of infertility: letrozole is now first line treatment for infertility as it improves live birth rates while reducing multiple pregnancies compared with clomiphene citrate.

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KW - General medicine

KW - Womenˈs health

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ER -

Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

Other files and links

Fingerprint

Cite this