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POLYCYSTIC OVARIAN SYNDROME
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 Ovarian Syndrome References

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  3. Benjamins LJ, Barratt MS. Evaluation and management of polycystic ovary syndrome. J Pediatr Health Care. 2009;23(5):337-343. http://www.ncbi.nlm.nih.gov/pubmed/?term=19720270. PMID: 19720270
  4. ACOG Committee on Practice Bulletins-Gynecology. ACOG practice bulletin no. 108: polycystic ovary syndrome. Obstet Gynecol. 2009 Oct;114(4):936-949. http://www.ncbi.nlm.nih.gov/pubmed/?term=19888063. PMID: 19888063
  5. Diamanti-Kandarakis E. PCOS in adolescents. Best Pract Res Clin Obstet Gynaecol. 2010 Apr;24(2):173-183. http://www.ncbi.nlm.nih.gov/pubmed/?term=19932060[uid]. PMID: 19932060
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  8. Marx T, Mehta A. Polycystic ovary syndrome: pathogenesis and treatment over the short and long term. Cleve Clin J Med. 2003 Jan;70(1):31-45. http://www.ncbi.nlm.nih.gov/pubmed/?term=12549723. PMID: 12549723
  9. Glintborg D, Andersen M. An update on the pathogenesis, inflammation, and metabolism in hirsutism and polycystic ovary syndrome. Gynecol Endocrinol. 2010 Apr;26(4):281-296. http://www.ncbi.nlm.nih.gov/pubmed/?term=20141388. PMID: 20141388
  10. Pasquali R, Gambineri A. Insulin-sensitizing agents in polycystic ovary syndrome. Eur J Endocrinol. 2006 Jun;154(6):763-775. http://www.ncbi.nlm.nih.gov/pubmed/?term=16728533. PMID: 16728533
  11. Norman R, Kidson W, et al. Metformin and intervention in polycystic ovary syndrome. Med J Aust. 2001 Jun;174(11):580-583. http://www.ncbi.nlm.nih.gov/pubmed/?term=11453331. PMID: 11453331
  12. Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician. 2009 Apr;79(8):671-676. PMID: 19405411
  13. Norman R, Wu R, Stankiewicz M. Polycystic ovary syndrome. Med J Aust. 2004 Feb;180(3):132-137. http://www.ncbi.nlm.nih.gov/pubmed/?term=14748678. PMID: 14748678
  14. Sheehan MT. Polycystic ovarian syndrome: diagnosis and management. Clin Med Res. 2004 Feb;2(1):13-27. http://www.ncbi.nlm.nih.gov/pubmed/?term=15931331. PMID: 15931331
  15. Schroeder BM. ACOG releases guidelines on diagnosis and management of polycystic ovary syndrome. Am Fam Physician. 2003 Apr;67(7):1619-1622. http://www.ncbi.nlm.nih.gov/pubmed/?term=12722867. PMID: 12722867
  16. Richardson MR. Current perspectives in polycystic ovary syndrome. Am Fam Physician. 2003 Aug;68(4):697-704. PMID: 12952386
  17. The Royal College of Obstetricians and Gynaecologists. Long-term consequences of polycystic ovary syndrome. Guideline no. 33. Agency for Healthcare Research and Quality. May 2003. http://www.guideline.gov.
  18. Stankiewicz M, Norman R. Diagnosis and management of polycystic ovary syndrome: a practical guide. Drugs. 2006;66(7):903-912. http://www.ncbi.nlm.nih.gov/pubmed/?term=16740005. PMID: 16740005
  19. Srikanthan P, Korenman S, Davis S. Polycystic ovarian syndrome: the next cardiovascular dilemma in women?. Endocrinol Metab Clin North Am. 2006 Sep;35(3):611-631. http://www.ncbi.nlm.nih.gov/pubmed/?term=16959589. PMID: 16959589
  20. Vrbikova J, Cibula D. Combined oral contraceptives in the treatment of polycystic ovary syndrome. Hum Reprod Update. 2005;11(3):277-291. http://www.ncbi.nlm.nih.gov/pubmed/?term=15790599. PMID: 15790599
  21. Wooltorton E. Diane-35 (Cyproterone acetate): safety concerns. Can Med Assoc J. 2003 Feb;168(4):455-456. http://www.ncbi.nlm.nih.gov/pubmed/?term=12591790. PMID: 12591790
  22. Farquhar C, Lee O, Toomath R, et al. Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne (Cochrane Review). The Cochrane Library, Issue 2. Chichester, UK: John Wiley and Sons, Ltd; 2004.
  23. MedWormhttp://www.medworm.com/rss/index.php/OBGYN/29/http://www.medworm.com/rss/medicalfeeds/specialities/OBGYN.xml
  24. Legro RS, Arslanian SA, Ehrmann DA, et al; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565-4592. doi: 10.1210/jc.2013-2350. PMID: 24151290
  25. Legro RS, Brzyski RG, Diamond MP, et al; NICHD Reproductive Medicine Network. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014 Jul 10;371(2):119-129. doi: 10.1056/NEJMoa1313517. PMID: 25006718
  26. Goodman NF, Cobin RH, Futterweit W, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - part 1. Endocr Pract. 2015 Nov;21(11):1291-1300. doi: 10.4158/EP15748.DSC. Accessed 18 Oct 2016. PMID: 26509855
  27. Goodman NF, Cobin RH, Futterweit W, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome - part 2. Endocr Pract. 2015 Dec;21(12):1415-1426. doi: 10.4158/EP15748.DSCPT2. Accessed 19 Oct 2016. PMID: 26642102
  28. National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment. NICE. https://www.nice.org.uk. Aug 2016. Accessed 02 Mar 2017.
  29. Wang R, Kim BV, van Wely M, et al. Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis. BMJ. 2017 Jan 31;356:j138. doi: 10.1136/bmj.j138. Accessed 02 May 2017. PMID: 28143834
  30. Teede HJ, Misso ML, Costello MF, et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2018 Jul 19. doi: 10.1111/cen.13795. Accessed 06 Aug 2018. PMID: 30024653
  31. Centre for Research Excellence in Polycystic Ovary Syndrome (CREPCOS), European Society of Human Reproduction and Embryology (ESHRE) and American Society of Reproductive Medicine (ASRM). International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS). ESHRE. https://www.eshre.eu. 2018. Accessed 06 Aug 2018.
  32. Barbieri RL, Ehrmann DA. Treatment of polycystic ovary syndrome in adults. UpToDate. https://www.uptodate.com. 29 Mar 2019.
  33. Elsevier Point of Care. Polycystic ovary syndrome. ClinicalKey. https://www.clinicalkey.com. 06 May 2022. Accessed 28 Oct 2022.
  34. Al Wattar BH, Fisher M, Bevington L, et al. Clinical practice guidelines on the diagnosis and management of polycystic ovary syndrome: a systematic review and quality assessment study. J Clin Endocrinol Metab. 2021 Jul 13;106(8):2436-2446. doi: 10.1210/clinem/dgab232. PMID: 33839790
  35. The Royal College of Obstetricians and Gynaecologists. Long-term consequences of polycystic ovary syndrome. Guideline no. 33. Agency for Healthcare Research and Quality. http://www.guideline.gov. May 2003.
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