Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome

Journal article


Teede, Helena J., Misso, Marie L., Costello, Michael F., Dokras, Anuja, Laven, Joop, Moran, Lisa, Piltonen, Terhi, Norman, Robert J., International PCOS Network, , Brennan, Leah and International PCOS Network. (2018) Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clinical Endocrinology. 89(3), pp. 251 - 268. https://doi.org/10.1111/cen.13795
AuthorsTeede, Helena J., Misso, Marie L., Costello, Michael F., Dokras, Anuja, Laven, Joop, Moran, Lisa, Piltonen, Terhi, Norman, Robert J., International PCOS Network, , Brennan, Leah and International PCOS Network
Abstract

Study Question What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? Summary Answer International evidence‐based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence‐based care and improve the experience and health outcomes of women with PCOS. What is Known Already Previous guidelines either lacked rigorous evidence‐based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. Study Design, Size, Duration International evidence‐based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II‐compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. Participants/Materials, Setting, Methods Governance included a six continent international advisory and a project board, five guideline development groups (GDGs), and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society‐nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis, and translation experts. Thirty‐seven societies and organizations covering 71 countries engaged in the process. Twenty face‐to‐face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence‐based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels. Main Results and the Role of Chance The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: (a) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; (b) reducing unnecessary testing; (c) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and (d) emphasizing evidence based medical therapy and cheaper and safer fertility management. Limitations, Reasons for Caution Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided. Wider Implications of the Findings The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program.

Keywordsassessment; evidence-based; GRADE; guideline; management; polycystic ovary syndrome
Year2018
JournalClinical Endocrinology
Journal citation89 (3), pp. 251 - 268
PublisherWiley-Blackwell Publishing Ltd.
ISSN0300-0664
Digital Object Identifier (DOI)https://doi.org/10.1111/cen.13795
Scopus EID2-s2.0-85050494365
Open accessOpen access
Page range251 - 268
Research GroupSchool of Philosophy
Publisher's version
License
Grant IDNHMRC/1078444
Additional information

Please refer to the full article for a complete list of the International PCOS Network collaborators.

Place of publicationUnited Kingdom
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Maternal controlling feeding behaviours and child eating in preschool-aged children
Moroshko, Irina and Brennan, Leah. (2013) Maternal controlling feeding behaviours and child eating in preschool-aged children. Nutrition and Dietetics. https://doi.org/10.1111/j.1747-0080.2012.01631.x
Intensive medical weight loss or laparoscopic adjustable gastric banding in the treatment of mild to moderate obesity : long-term follow-up of a prospective randomised trial
O'Brien, Paul Edmond, Brennan, Leah, Laurie, Cheryl and Brown, Wendy. (2013) Intensive medical weight loss or laparoscopic adjustable gastric banding in the treatment of mild to moderate obesity : long-term follow-up of a prospective randomised trial. Obesity Surgery. https://doi.org/10.1007/s11695-013-0990-3
Physiological and behavioural outcomes of a randomised controlled trial of a cognitive behavioural lifestyle intervention for overweight and obese adolescents
Brennan, Leah, Walkley, Jeff, Wilks, Ray, Fraser, Steve and Greenway, Kate. (2013) Physiological and behavioural outcomes of a randomised controlled trial of a cognitive behavioural lifestyle intervention for overweight and obese adolescents. Obesity Research and Clinical Practice. https://doi.org/10.1016/j.orcp.2012.02.010
A cluster randomised controlled trial of a telephone-based parent intervention to increase preschoolers' fruit and vegetable consumption
Wyse, Rebecca, Wolfenden, Luke, Campbell, Elizabeth, Campbell, Karen, Wiggers, John, Brennan, Leah, Fletcher, Amanda, Bowman, Jenny and Heard, Todd. (2012) A cluster randomised controlled trial of a telephone-based parent intervention to increase preschoolers' fruit and vegetable consumption. American Journal of Clinical Nutrition: A journal reporting the practical application of our world-wide knowledge of nutrition. 96(1), pp. 102 - 110. https://doi.org/10.3945/ajcn.111.030585
Predictors of attrition in bariatric aftercare : a systematic review of the literature
Moroshko, Irina, Brennan, Leah and O'Brien, Paul. (2012) Predictors of attrition in bariatric aftercare : a systematic review of the literature. Obesity Surgery. 22(10), pp. 1640 - 1647. https://doi.org/10.1007/s11695-012-0691-3
Promoting protective factors for young adolescents : ABCD Parenting Young Adolescents Program randomised controlled trial
Burke, Kylie, Brennan, Leah and Cann, Warren. (2012) Promoting protective factors for young adolescents : ABCD Parenting Young Adolescents Program randomised controlled trial. Journal of Adolescence. 35(5), pp. 1315 - 1328. https://doi.org/10.1016/j.adolescence.2012.05.002
Parenting styles, communication and child/adolescent diets andweight status : let's talk about it
Parletta, Natalie, Peters, Jacqueline, Owen, Amber, Tsiros, Margarita and Brennan, Leah. (2012) Parenting styles, communication and child/adolescent diets andweight status : let's talk about it. Early Child Development and Care. 182(8), pp. 1089 - 1103. https://doi.org/10.1080/03004430.2012.678597
Does exercise improve weight loss after bariatric surgery? : A systematic review
Egberts, Kristine, Brown, Wendy, Brennan, Leah and O'Brien, Paul. (2012) Does exercise improve weight loss after bariatric surgery? : A systematic review. Obesity Surgery. 22(2), pp. 335 - 341. https://doi.org/10.1007/s11695-011-0544-5
Treatment acceptability and psychosocial outcomes of a randomised controlled trial of a cognitive behavioural lifestyle intervention for overweight and obese adolescents
Brennan, Leah, Wilks, Ray, Walkley, Jeff, Fraser, Steve and Greenway, Kate. (2012) Treatment acceptability and psychosocial outcomes of a randomised controlled trial of a cognitive behavioural lifestyle intervention for overweight and obese adolescents. Behaviour Change. 29(1), pp. 36 - 62. https://doi.org/10.1017/bec.2012.5
Parent- and adolescent-reported barriers to participation in an adolescent overweight and obesity intervention
Brennan, Leah, Walkley, Jeff and Wilks, Ray. (2012) Parent- and adolescent-reported barriers to participation in an adolescent overweight and obesity intervention. Obesity: a resourch journal. 20(6), pp. 1319 - 1324. https://doi.org/10.1038/oby.2011.358
Validity of the beck depression inventory as a screening tool for a clinical mood disorder in bariatric surgery candidates
Hayden, Melissa J., Brown, Wendy A., Brennan, Leah and O'Brien, Paul Edmond. (2012) Validity of the beck depression inventory as a screening tool for a clinical mood disorder in bariatric surgery candidates. Obesity Surgery. 22(11), pp. 1666 - 1675. https://doi.org/10.1007/s11695-012-0682-4
In people with poorly controlled type 2 diabetes, cognitive behaviour therapy combined with motivational enhancement therapy reduces HbA1c after 12 months
Brennan, Leah. (2011) In people with poorly controlled type 2 diabetes, cognitive behaviour therapy combined with motivational enhancement therapy reduces HbA1c after 12 months. Worldviews on Evidence-Based Nursing. 14(3), pp. 72 - 73. https://doi.org/10.1136/ebn1164
In people with poorly controlled type 2 diabetes, cognitive behaviour therapy combined with motivational enhancement therapy reduces HbA1c after 12 months
Brennan, Leah. (2011) In people with poorly controlled type 2 diabetes, cognitive behaviour therapy combined with motivational enhancement therapy reduces HbA1c after 12 months. Worldviews on Evidence-Based Nursing. 14(3), pp. 72 - 73. https://doi.org/10.1136/ebn1164
Predictors of dropout in weight loss interventions :a systematic review of the literature
Moroshko, Irina, Brennan, Leah and O'Brien, Paul Edmond. (2011) Predictors of dropout in weight loss interventions :a systematic review of the literature. Obesity Reviews. 12(11), pp. 912 - 934. https://doi.org/10.1111/j.1467-789X.2011.00915.x
Primary Goals for Weight Loss Questionnaire (PGWLQ) :Development and Psychometric Evaluation in Overweight and Obese Adults
Murphy, Kylie, Brennan, Leah, Walkley, Jeff, Reece, John and Little, Emma. (2011) Primary Goals for Weight Loss Questionnaire (PGWLQ) :Development and Psychometric Evaluation in Overweight and Obese Adults. Behaviour Change. 28(1), pp. 29 - 43. https://doi.org/10.1375/bech.28.1.29
Self-Monitoring in the Treatment of Overweight Adolescents
Sandilands, Mary, Brennan, Leah, Walkley, Jeff, Fraser, Steve and Greenway, Kate. (2011) Self-Monitoring in the Treatment of Overweight Adolescents. Behaviour Change. 28(2), pp. 97 - 109. https://doi.org/10.1375/bech.28.2.97
Predicting treatment initiation in a family-based adolescent overweight and obesity intervention
Dhingra, Akshay, Brennan, Leah and Walkley, Jeff. (2011) Predicting treatment initiation in a family-based adolescent overweight and obesity intervention. Obesity: a resourch journal. 19(6), pp. 1307 - 1310. https://doi.org/10.1038/oby.2010.289
Psychosocial predictors of eating disorder risk in overweight and obese treatment seeking adolescents
Russo, Jade, Brennan, Leah, Walkley, Jeff, Fraser, Steve and Greenway, Kate. (2011) Psychosocial predictors of eating disorder risk in overweight and obese treatment seeking adolescents. Behaviour Change. 28(3), pp. 111 - 127. https://doi.org/10.1375/bech.28.3.111
A pilot study of a telephone-based parental intervention to increase fruit and vegetable consumption in 3 to 5 year old children
Wyse, Rebecca, Wolfenden, Luke, Campbell, Elizabeth, Campbell, Karen, Brennan, Leah, Fletcher, Amanda, Bowman, Jenny, Heard, Todd and Wiggers, John. (2011) A pilot study of a telephone-based parental intervention to increase fruit and vegetable consumption in 3 to 5 year old children. Public Health Nutrition. 14(12), pp. 2245 - 2253. https://doi.org/10.1017/S1368980011001170
Reliability of the school food checklist for in-school audits and photograph analysis of children's school lunches
Mitchell, Sarah, Miles, Cara, Brennan, Leah and Matthews, Jan. (2010) Reliability of the school food checklist for in-school audits and photograph analysis of children's school lunches. Journal of Human Nutrition and Dietetics. 23(1), pp. 48 - 53. https://doi.org/10.1111/j.1365-277X.2009.00996.x
A randomised controlled trial of the efficacy of the ABCD Parenting Young Adolescents Program : rationale and methodology
Burke, Kylie, Brennan, Leah and Roney, Sarah. (2010) A randomised controlled trial of the efficacy of the ABCD Parenting Young Adolescents Program : rationale and methodology. Child and Adolescent Psychiatry and Mental Health. 4(22), pp. 1 - 14. https://doi.org/10.1186/1753-2000-4-22
Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study
Campbell, Karen, Andrianopoulos, Nick, Hesketh, Kylie, Ball, Kylie, Crawford, David, Brennan, Leah, Corsini, Nadia and Timperio, Anna. (2010) Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study. Appetite. 55(1), pp. 84 - 88. https://doi.org/10.1016/j.appet.2010.04.006
A cluster randomised trial of a telephone-based intervention for parents to increase fruit and vegetable consumption in their 3- to 5-year-old children: Study protocol
Wyse, Rebecca, Wolfenden, Luke, Campbell, Elizabeth, Brennan, Leah, Campbell, Karen, Fletcher, Amanda, Bowman, Jenny, Heard, Todd and Wiggers, John. (2010) A cluster randomised trial of a telephone-based intervention for parents to increase fruit and vegetable consumption in their 3- to 5-year-old children: Study protocol. BMC Public Health. 10(216), pp. 1 - 12. https://doi.org/10.1186/1471-2458-10-216
Adolescent and parent content preferences and predictors of intention to use an online healthy weight website for adolescents
Baulch, Jacqueline, Chester, Andrea and Brennan, Leah. (2010) Adolescent and parent content preferences and predictors of intention to use an online healthy weight website for adolescents. E - Journal of Applied Psychology. 6(1), pp. 19 - 26. https://doi.org/10.7790/ejap.v6i1.173
Changes in the content of children's school lunches across the school week
Brennan, Leah, Miles, Cara, Mitchell, Sarah and Matthews, Jan. (2010) Changes in the content of children's school lunches across the school week. Health Promotion Journal of Australia. 21(3), pp. 196 - 201.
Maternal psychosocial predictors of controlling parental feeding styles and practices
Mitchell, Sarah, Brennan, Leah, Hayes, Louise and Miles, Cara L.. (2009) Maternal psychosocial predictors of controlling parental feeding styles and practices. Appetite. 53(3), pp. 384 - 389. https://doi.org/10.1016/j.appet.2009.08.001
Health-related quality of life in obese children and adolescents
Tsiros, Margarita D., Olds, Timothy S., Buckley, Jonathan David, Grimshaw, Paul, Brennan, Leah, Walkley, Jeff, Hills, Andrew Peter, Howe, Peter and Coates, Alison M.. (2009) Health-related quality of life in obese children and adolescents. International Journal of Obesity. 33(4), pp. 387 - 400. https://doi.org/10.1038/ijo.2009.42
A cognitive behavioural intervention for overweight and obese adolescents illustrated by four case studies
Brennan, Leah, Walkley, Jeff, Lukeis, Sarah, Risteska, Anica, Archer, Lisa, Digre, Ellen, Fraser, Steve F. and Greenway, Kate. (2009) A cognitive behavioural intervention for overweight and obese adolescents illustrated by four case studies. Behaviour Change. 26(3), pp. 190 - 213. https://doi.org/10.1375/bech.26.3.190
Treatment alternatives for overweight and obesity: The role of online interventions
Baulch, Jacqueline, Chester, Andrea and Brennan, Leah. (2008) Treatment alternatives for overweight and obesity: The role of online interventions. Behaviour Change. 25(1), pp. 1 - 14. https://doi.org/10.1375/bech.25.1.1
Motivational interviewing and cognitive behaviour therapy in the treatment of adolescent overweight and obesity: Study design and methodology
Brennan, Leah, Walkley, Jeff, Fraser, Steve F., Greenway, Kate and Wilks, Ray. (2008) Motivational interviewing and cognitive behaviour therapy in the treatment of adolescent overweight and obesity: Study design and methodology. Contemporary Clinical Trials. 29(3), pp. 359 - 375. https://doi.org/10.1016/j.cct.2007.09.001
Cognitive behavioural therapy improves diet and body composition in overweight and obese adolescents
Tsiros, Margarita D., Parletta, Natalie, Brennan, Leah, Coates, Alison M., Walkley, Jeff, Petkov, John, Howe, Peter, David and Buckley, Jonathan David. (2008) Cognitive behavioural therapy improves diet and body composition in overweight and obese adolescents. American Journal of Clinical Nutrition. 87(5), pp. 1134 - 1140.