Treatment Guideline Chart
Polycystic ovarian syndrome (PCOS) is the accumulation of underdeveloped follicles in the ovaries due to anovulation. It is characterized by menstrual abnormalities and clinical or biochemical features of hyperandrogenism.
It results mainly from abnormal steroidogenesis that may be caused by insulin resistance leading to hyperinsulinemia.
There is increased sensitivity to androgens and the majority of women have elevated androgen levels.

Polycystic%20ovarian%20syndrome Management

Follow Up

Long-term Follow-up

  • Monitor for onset of the following associated diseases:


  • Measure waist circumference and calculate BMI yearly 
  • Measure a fasting lipid profile at diagnosis regardless of patient’s age 
  • Subsequent measurement should be guided by the test result and global CVD risk


  • Screen blood lipid levels every 6 months or more frequently if with interval weight gain 

Type 2 DM, Impaired Glucose Tolerance, Gestational Diabetes   

  • Baseline assessment of glycemic status with an oral glucose tolerance test (OGTT), fasting plasma glucose or HbA1c should be performed in all women with PCOS and thereafter, every 1-3 years based on the presence of other diabetes risk factors
  • OGTT is recommended in high-risk risk women with PCOS with BMI >25 kg/m2 (Asians >23 kg/m2), history of abnormal glucose tolerance, family history of type 2 DM, hypertension or high-risk ethnicity 
    • HbA1c may be done if OGTT cannot be performed
  • Offer OGTT to all women with PCOS when planning pregnancy or seeking fertility treatment due to the increased risk of hyperglycemia and comorbidities in pregnancy
    • If not performed prior to conception, offer OGTT at <20 weeks gestation and at 24-28 weeks gestations for all women with PCOS


  • All women with PCOS should be evaluated for individual CV risk factors and global CVD risk
  • Monitor BP at every visit or more frequently depending on patient’s global CVD risk
  • Measure weight, height and waist circumference, calculate BMI
    • Monitor weight at every visit or at 6-12 monthly with subsequent visits as agreed upon by the physician and the patient
    • Follow World Health Organization (WHO) guidelines for BMI categories and waist circumference taking note of ethnic and adolescent ranges
    • Consider Asian and high-risk ethnic groups including waist circumference monitoring 

Endometrial Cancer   

  • Transvaginal ultrasound and/or endometrial biopsy are recommended in patients with persistent thickened endometrium and/or risk factors, eg excess weight, prolonged amenorrhea, abnormal vaginal bleeding 
    • Routine screening with ultrasound for endometrial thickness in PCOS is not recommended


  • Consider screening for OSA in patients with PCOS to identify and relieve related symptoms and not for improving cardiometabolic risk as evidence is inadequate for the metabolic benefits of OSA treatment in PCOS
  • Screen with symptom assessment, preferably with the Berlin questionnaire, and if positive, consider a specialist referral for further evaluation
Editor's Recommendations
Special Reports