International evidence-based recommendations for polycystic ovary syndrome in adolescents
Abstract Background During adolescence, accurate diagnostic criteria and/or identification of adolescents “at risk” of polycystic ovary syndrome (PCOS) are critical to establish appropriate screening, treatment, and lifelong health plans. The 2023 International Evidence-Based Guideline for PCOS aime...
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2025-03-01
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| Online Access: | https://doi.org/10.1186/s12916-025-03901-w |
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| author | Alexia S Peña Selma Feldman Witchel Jacky Boivin Tania S. Burgert Carolyn Ee Kathleen M Hoeger Marla E. Lujan Aya Mousa Sharon Oberfield Chau Thien Tay Helena Teede |
| author_facet | Alexia S Peña Selma Feldman Witchel Jacky Boivin Tania S. Burgert Carolyn Ee Kathleen M Hoeger Marla E. Lujan Aya Mousa Sharon Oberfield Chau Thien Tay Helena Teede |
| author_sort | Alexia S Peña |
| collection | DOAJ |
| description | Abstract Background During adolescence, accurate diagnostic criteria and/or identification of adolescents “at risk” of polycystic ovary syndrome (PCOS) are critical to establish appropriate screening, treatment, and lifelong health plans. The 2023 International Evidence-Based Guideline for PCOS aimed to provide the most up-to-date evidence-based recommendations to improve health outcomes for individuals with PCOS, emphasizing accurate and timely diagnosis of PCOS from adolescence. Methods The best practice methods following the Appraisal of Guidelines for Research and Evaluation (AGREE-II) criteria were applied. Healthcare professionals and patients/consumers reviewed extensive evidence synthesis/meta-analysis for 55 prioritized clinical questions. Databases (OVID MEDLINE, All EBM, PsycInfo, EMBASE, CINAHL) were searched until August 2022 as part of the 2023 update of the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework guided experts on evidence quality, feasibility, acceptability, cost, implementation, and ultimately recommendation strength. Results This manuscript focuses on the adolescent-specific recommendations of the 2023 Guideline. The diagnosis is based on the presence of both irregular menstrual cycles (defined according to the time postmenarche) and clinical/biochemical hyperandrogenism following the exclusion of other disorders that mimic PCOS. Adolescents with only one of these features can be considered “at risk” of PCOS requiring the management of symptoms and ongoing follow-up. Polycystic ovarian morphology on pelvic ultrasonography or anti-Müllerian hormone levels should not be used for diagnosis during adolescence. Lifelong health planning is recommended to include healthy lifestyles, screening for depression and metabolic features and the transition to adult care, all underpinned by shared decision-making. Healthcare professionals should explain weight-related health risks to adolescents, while minimizing weight stigma. In adolescents with PCOS or “at risk” of PCOS, combined oral contraceptive pills are indicated for menstrual irregularity and clinical hyperandrogenism, focusing on low dose preparations, and metformin could be considered for metabolic features and cycle regulation. Overall, the evidence is limited in adolescents with PCOS, and recommendations are based on low to moderate certainty evidence. Conclusions Extensive international engagement and rigorous processes generated International Guideline diagnostic criteria for adolescents that differ from adult criteria and clarified appropriate screening and management strategies for PCOS during adolescence. |
| format | Article |
| id | doaj-art-16874cdcc24e4ff181f5f3ed0383930b |
| institution | DOAJ |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-03-01 |
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| series | BMC Medicine |
| spelling | doaj-art-16874cdcc24e4ff181f5f3ed0383930b2025-08-20T03:01:41ZengBMCBMC Medicine1741-70152025-03-0123111310.1186/s12916-025-03901-wInternational evidence-based recommendations for polycystic ovary syndrome in adolescentsAlexia S Peña0Selma Feldman Witchel1Jacky Boivin2Tania S. Burgert3Carolyn Ee4Kathleen M Hoeger5Marla E. Lujan6Aya Mousa7Sharon Oberfield8Chau Thien Tay9Helena Teede10Discipline of Paediatrics and Endocrine Department, The University of Adelaide Robinson Research Institute and Women’s and Children’s HospitalDivision of Pediatric Endocrinology, UPMC Children’s Hospital of Pittsburgh, University of PittsburghSchool of Psychology, Cardiff UniversityUniversity of Missouri Kansas CityNICM Health Research Institute, Western Sydney UniversityUniversity of RochesterDivision of Nutritional Sciences, Cornell UniversityMonash Centre for Health Research & Implementation, School of Public Health and Preventive Medicine. Faculty of Medicine Nursing and Health Sciences, Monash UniversityDivision of Pediatric Endocrinology, Columbia University Irving Medical Center, CUIMC/Presbyterian HospitalMonash Centre for Health Research and Implementation, Monash UniversityMonash Centre for Health Research and Implementation, School of Clinical Sciences, Monash UniversityAbstract Background During adolescence, accurate diagnostic criteria and/or identification of adolescents “at risk” of polycystic ovary syndrome (PCOS) are critical to establish appropriate screening, treatment, and lifelong health plans. The 2023 International Evidence-Based Guideline for PCOS aimed to provide the most up-to-date evidence-based recommendations to improve health outcomes for individuals with PCOS, emphasizing accurate and timely diagnosis of PCOS from adolescence. Methods The best practice methods following the Appraisal of Guidelines for Research and Evaluation (AGREE-II) criteria were applied. Healthcare professionals and patients/consumers reviewed extensive evidence synthesis/meta-analysis for 55 prioritized clinical questions. Databases (OVID MEDLINE, All EBM, PsycInfo, EMBASE, CINAHL) were searched until August 2022 as part of the 2023 update of the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework guided experts on evidence quality, feasibility, acceptability, cost, implementation, and ultimately recommendation strength. Results This manuscript focuses on the adolescent-specific recommendations of the 2023 Guideline. The diagnosis is based on the presence of both irregular menstrual cycles (defined according to the time postmenarche) and clinical/biochemical hyperandrogenism following the exclusion of other disorders that mimic PCOS. Adolescents with only one of these features can be considered “at risk” of PCOS requiring the management of symptoms and ongoing follow-up. Polycystic ovarian morphology on pelvic ultrasonography or anti-Müllerian hormone levels should not be used for diagnosis during adolescence. Lifelong health planning is recommended to include healthy lifestyles, screening for depression and metabolic features and the transition to adult care, all underpinned by shared decision-making. Healthcare professionals should explain weight-related health risks to adolescents, while minimizing weight stigma. In adolescents with PCOS or “at risk” of PCOS, combined oral contraceptive pills are indicated for menstrual irregularity and clinical hyperandrogenism, focusing on low dose preparations, and metformin could be considered for metabolic features and cycle regulation. Overall, the evidence is limited in adolescents with PCOS, and recommendations are based on low to moderate certainty evidence. Conclusions Extensive international engagement and rigorous processes generated International Guideline diagnostic criteria for adolescents that differ from adult criteria and clarified appropriate screening and management strategies for PCOS during adolescence.https://doi.org/10.1186/s12916-025-03901-wAdolescentsGirlsPolycystic ovary syndromeEvidence-basedDiagnosisManagement |
| spellingShingle | Alexia S Peña Selma Feldman Witchel Jacky Boivin Tania S. Burgert Carolyn Ee Kathleen M Hoeger Marla E. Lujan Aya Mousa Sharon Oberfield Chau Thien Tay Helena Teede International evidence-based recommendations for polycystic ovary syndrome in adolescents BMC Medicine Adolescents Girls Polycystic ovary syndrome Evidence-based Diagnosis Management |
| title | International evidence-based recommendations for polycystic ovary syndrome in adolescents |
| title_full | International evidence-based recommendations for polycystic ovary syndrome in adolescents |
| title_fullStr | International evidence-based recommendations for polycystic ovary syndrome in adolescents |
| title_full_unstemmed | International evidence-based recommendations for polycystic ovary syndrome in adolescents |
| title_short | International evidence-based recommendations for polycystic ovary syndrome in adolescents |
| title_sort | international evidence based recommendations for polycystic ovary syndrome in adolescents |
| topic | Adolescents Girls Polycystic ovary syndrome Evidence-based Diagnosis Management |
| url | https://doi.org/10.1186/s12916-025-03901-w |
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