National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC.
Med J Aust. 2018 Oct 1;209(S7):S3-S8. doi: 10.5694/mja18.00656.
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.
我们制定了首个针对多囊卵巢综合征（PCOS）的国际循证诊断和管理指南，其中纳入了针对卫生专业人员和消费者的综合翻译资源。该指南的制定历时 2 年，由澳大利亚主导，汇聚了国际范围内的卫生专业人员和消费者，他们来自多个学科。该指南获得了澳大利亚国家卫生和医学研究委员会的批准，旨在为卫生专业人员和 PCOS 患者提供支持，以改善其医疗服务、健康结果和生活质量。一个强大的评估过程将能够进行实践基准测试并提供反馈，以进一步为循证实践提供信息。我们建议，这种方法可用于制定和实施其他妇女健康状况的指南。主要建议：建议涵盖以下广泛领域：根据生命阶段进行诊断、筛查和风险评估；情绪健康；健康的生活方式；非生育适应症的药物治疗；以及评估和治疗不孕。由于本指南的推荐，管理发生了以下变化：•诊断：▪当高雄激素血症和排卵功能障碍同时存在时，成年女性 PCOS 诊断无需行卵巢超声检查；▪对于初潮后 8 年内的年轻女性，需要同时存在高雄激素血症和排卵功能障碍，不建议进行卵巢超声检查，因为这与正常卵巢生理重叠；▪对于一些 PCOS 临床特征但诊断不明确的青少年，应视为“有风险”，并接受后续评估。•代谢并发症的筛查已得到细化，并纳入了 PCOS 状态和其他代谢风险因素。•不孕治疗：来曲唑现已成为治疗不孕的一线药物，与枸橼酸氯米酚相比，它可提高活产率，同时降低多胎妊娠的风险。
