Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC.
University of New South Wales, Sydney, NSW.
Med J Aust. 2024 Oct 7;221(7):389-395. doi: 10.5694/mja2.52432. Epub 2024 Sep 2.
The Australian-led 2023 International evidence-based guideline for the assessment and management of polycystic ovary syndrome was based on best available evidence, clinical expertise and consumer preference. It followed best practice, involved extensive evidence synthesis and applied relevant frameworks across evidence quality, feasibility, acceptability, cost and implementation. Thirty-nine societies and organisations covering 71 countries were engaged. The evidence in the assessment and management of polycystic ovary syndrome (PCOS) has generally improved in the past five years, but remains of low to moderate quality. The technical evidence report, 52 systematic reviews and analyses (approximately 6000 pages) underpin 77 evidence-based and 54 consensus recommendations, with 123 practice points.
Changes include: refinement of individual diagnostic criteria, a simplified diagnostic algorithm and inclusion of anti-Müllerian hormone levels as an alternative to ultrasound in adults only, and differentiation of adolescent and adult criteria; strengthening the recognition of broad features of PCOS including metabolic effects, cardiovascular disease, dermatological symptoms, sleep apnoea, a high prevalence of psychological features and a high risk of adverse pregnancy outcomes; emphasising the poorly recognised, diverse burden of disease, the vital need for greater health professional education, evidence-based patient information, improved models of care, shared decision making and research efforts to improve patient experience; maintained emphasis on healthy lifestyle, emotional wellbeing and quality of life, with awareness and consideration of weight stigma; and emphasising evidence-based medical therapy and cheaper and safer fertility management.
The 2023 guideline is approved by the National Health and Medical Research Council and provides clinicians and patients with clear advice on best practice in a common and neglected condition, based on the best available evidence, expert multidisciplinary input and consumer preferences. It provides vital, extensive patient and provider resources to enhance evidence-based care. The full guideline is available at www.monash.edu/medicine/mchri/pcos/guideline.
由澳大利亚主导的 2023 年国际循证多囊卵巢综合征评估和管理指南，是基于最佳现有证据、临床专业知识和消费者偏好制定的。它遵循最佳实践，涉及广泛的证据综合，并在证据质量、可行性、可接受性、成本和实施方面应用了相关框架。涵盖 71 个国家的 39 个学会和组织参与其中。在过去五年中，多囊卵巢综合征（PCOS）的评估和管理方面的证据有所提高，但仍然存在中低质量的情况。技术证据报告、52 项系统评价和分析（约 6000 页）为 77 项循证和 54 项共识建议提供了支持，其中包括 123 个实践要点。
变化包括：细化了个别诊断标准，简化了诊断算法，并仅在成人中纳入抗苗勒管激素水平作为超声的替代方法，以及区分青少年和成人标准；加强对 PCOS 广泛特征的认识，包括代谢影响、心血管疾病、皮肤症状、睡眠呼吸暂停、心理特征高发和不良妊娠结局风险高；强调了认识不足、疾病负担多样化，迫切需要加强卫生专业人员教育、提供循证患者信息、改善护理模式、共同决策和研究工作，以改善患者体验；继续强调健康的生活方式、情绪健康和生活质量，同时要意识到和考虑体重污名化；并强调基于证据的医学治疗和更便宜、更安全的生育管理。
该 2023 年指南已获得澳大利亚国家卫生与医学研究理事会的批准，为临床医生和患者提供了基于最佳现有证据、多学科专家意见和消费者偏好的常见且被忽视的疾病的最佳实践建议。它为提高循证护理提供了重要的、广泛的患者和提供者资源。完整的指南可在 www.monash.edu/medicine/mchri/pcos/guideline 上获取。
