CLINICAL UPDATE POLYCYSTIC OVARIAN SYNDROME 2018
A recent update on the diagnosis and treatment of polycystic ovary syndrome (PCOS) has been published by an Australian group for use in the Australian Health system. It would be appropriate for PRP to adopt its recommendations.
Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome
Helena J Teede, Marie L Misso, Jacqueline A Boyle, Rhonda M Garad, Veryan McAllister, Linda Downes, Melanie Gibson, Roger J Hart, Luk Rombauts, Lisa Moran, Anuja Dokras, Joop Laven, Terhi Piltonen, Raymond J Rodgers, Mala Thondan, Michael F Costello and Robert J Norman, on behalf of the International PCOS Network
https://www.mja.com.au/journal/2018/209/7/translation-and-implementation-australian-led-pcos-guideline-clinical-summary
ROTTERDAM DIAGNOSTIC CRITERIA FOR PCOS
Rotterdam diagnostic criteria requires two of:
1. Oligo- or anovulation;
2. Clinical and/or biochemical signs of hyperandrogenism;
3. Polycystic ovaries; and exclusion of other aetiologies of the above features
ULTRASOUND “RULES” 2018.
1. Preferred terminology for US appearances is POLYCYSTIC OVARIAN MORPHOLOGY (PCOM).
2. Ultrasound should not be used for the diagnosis of PCOS in adolescence, due to the high incidence of multi-follicular ovaries in this life stage. This means age menarche plus 8 years or more practically 20 years of age.
3. The transvaginal ultrasound approach should be used in the diagnosis of PCOS if acceptable/appropriate.
4. Using ultrasound transducers with a frequency > 8MHz, the threshold for PCOM should be a follicle number per ovary of ≥ 18-20 and/or an ovarian volume > 10 ml, ensuring no corpora lutea, cysts or dominant follicles are present in one or both ovaries.
If using lower resolution ultrasound transducers with a frequency < 8MHz, the threshold for PCOM should be a follicle number per ovary of ≥ 12 and/or an ovarian volume ≥ 10ml.
5. Transabdominal ultrasound should primarily report ovarian volume with a threshold of ≥ 10ml, given the difficulty of accurately assessing follicle number with this approach.
6. Clear reporting is required of antral follicle count and ovarian volume on ultrasound. Minimum reporting standards should include:
• Last menstrual period,
• Transducer frequency and approach/route assessed (TV or TA)
• Total follicle number per ovary measuring 2-9mm
• Three dimensions of each ovary and the volume
• Reporting of endometrial thickness and appearance is preferred – 3-layer endometrial assessment may be useful and can exclude endometrial pathology
• Other ovarian and uterine pathology, including ovarian cysts, corpus luteum, dominant follicles > equal 10mm