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SWCH18 Michael Costello PDF
SWCH18 Michael Costello PDF
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International evidence based PCOS guidelines Evidence-based guidelines
• 1st ever internationally endorsed & evidence based
• Not yet published – aiming for August 2018 Evidence from
Clinical expertise
• Covers assessment, diagnosis & management of PCOS research
• 5 Guideline Development Groups (GDG)
1. Diagnosis & assessment Evidence
2. Assessment & management of emotional wellbeing based practice
3. Lifestyle intervention
4. Pharmacological treatment for non-fertility indications Consumer
Cost effectiveness
5. Assessment & management of infertility perspective
• Followed GRADE process to rate the strength of recommendations
Comparing US images Changes in the mean or median of follicle number per ovary
(FNPO) in healthy women with regular menstrual cycles over time.
Dewailly 2014
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Diagnosis of PCOS in Adolescents Assessment of Hyperandrogenism
• Rotterdam 2003 criteria but • Clinical Hyperandrogenism
A. > 2 years after onset of menarche • hirsutism
• acne
B. must have both
• female pattern hair loss
o ovulatory dysfunction and;
o androgen excess
• Biochemical Hyperandrogenism
• bioavailable testosterone, calculated free
C. Ultrasound not recommended testosterone or free androgen index
• consider AD & DHEAS if total testosterone or free
testosterone not elevated
Management of excess weight in PCOS Use of combined oral contraceptive pill in PCOS
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Ovulation Induction in PCOS
• Exclude pregnancy prior to starting OI
• Infertile anovulatory women with no other infertility
factors
• Letrozole is 1st line pharmacological therapy 1,2
• Risk of multiple pregnancy is less with letrozole
compared with clomiphene citrate 3
• Consider monitoring to reduce risk of multiple
pregnancy 1. Wang, Costello et al BMJ 2017 20/30
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Letrozole: risk of congenital anomalies in published literature Adjuvant metformin use
n = 10 studies • Addition of metformin to FSH OI improves
ovulation, pregnancy and live-birth rates 1
• Addition of metformin to IVF treatment
improves clinical pregnancy rate and
lowers the risk of OHSS 2,3
Take home messages: Current guidelines Take home messages in general practice
• 1st International evidence based guidelines on • Use Rotterdam 2003 criteria for diagnosis of
PCOS to be published in 2018 PCOS
• Evidence based guidelines incorporate • Ultrasound not recommended for diagnosis of
PCOS in adolescents
• best evidence from research +
• Use COCP for treatment of clinical
• clinical expertise + hyperandrogenism & irregular menstrual cycles
• patient values + • No specific OCP is to be recommended over
• cost-effectiveness another
Take home messages in general practice Take home messages in general practice
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Thank you