Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 13;106(8):2436-2446.
doi: 10.1210/clinem/dgab232.

Clinical Practice Guidelines on the Diagnosis and Management of Polycystic Ovary Syndrome: A Systematic Review and Quality Assessment Study

Bassel H Al Wattar  1   2 , Maria Fisher  3 , Laura Bevington  3 , Vikram Talaulikar  2   4 , Melanie Davies  2   4 , Gerrad Conway  2   4 , Ephia Yasmin  2   4
Affiliations

Clinical Practice Guidelines on the Diagnosis and Management of Polycystic Ovary Syndrome: A Systematic Review and Quality Assessment Study

Bassel H Al Wattar et al. J Clin Endocrinol Metab. .

Abstract

Context: Clinical practice guidelines (CPGs) are key instruments to implement the practice of evidence-based medicine. We aimed to evaluate the methodological quality and variations in CPGs recommendations on the diagnosis and management of polycystic ovary syndrome (PCOS).

Evidence acquisition: We searched MEDLINE, EMBASE, and CENTRAL until December 2020 for all evidence-based CPGs and consensus statements on PCOS. We extracted data in duplicate to map clinical recommendations across prespecified disease domains and assessed CPGs methodological quality of using the Appraisal of Guidelines, Research & Evaluation II tool.

Evidence synthesis: We included 13 PCOS CPGs published between 2007 and 2018. CPGs recommendations were mostly focused on screening for and managing metabolic disease (12/13, 92%), followed by cardiovascular risk assessment (10/13, 77%). Mental health (8/13, 62%) and diagnosis in adolescents (7/13, 54%) were the least reported domains. Most CPGs had a high quality for scope and purpose description (12/13, 92%) while stakeholder's involvement and applicability of recommendations to clinical practice were appropriate in only 2 CPGs (2/13, 15%). We identified inconsistency in recommendations on PCOS diagnosis in adolescents, optimal lifestyle interventions, hirsutism and acne treatments, interventions to reduce the risk of ovarian hyperstimulation syndrome, the frequency and screening criteria for metabolic and cardiovascular disease, and optimal screening tools for mental health illness in women with PCOS.

Conclusion: Current CPGs on the diagnosis and management of PCOS vary in their scope and methodological quality, which may hinder evidence translation into clinical practice. We identified disease domains with existing evidence gap to guide future research and guideline updates.

Keywords: AGREE tool; clinical CPGs; polycystic ovary syndrome; quality; systematic review.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Selection and inclusion process for the systematic review on the quality of evidence-based clinical practice guidelines on polycystic ovarian syndrome.
Figure 2.
Figure 2.
Quality of included evidence-based clinical practice guidelines on polycystic ovarian syndrome using the AGREE II tool. Clinical practice guidelines were evaluated for their development methodology and reporting in 23 items grouped into 6 domains using the AGREE II tool. Guidelines that scored in the top tertile were reported to have high quality for each of the domains.
See this image and copyright information in PMC

Comment in

References

    1. Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016;31(12):2841-2855. - PubMed
    1. Azziz R, Carmina E, Chen Z, et al. . Polycystic ovary syndrome. Nat Rev Dis Primers. 2016;2:16057. - PubMed
    1. Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017;102(2):604-612. - PMC - PubMed
    1. Al Wattar BH, Bueno A, Martin MG, et al. . Harmonizing research outcomes for polycystic ovary syndrome (HARP), a marathon not a sprint: current challenges and future research need. Hum Reprod. 2021;36(3):523-528. - PubMed
    1. Al Wattar BH, Teede H, Garad R, et al. . Harmonising research outcomes for polycystic ovary syndrome: an international multi-stakeholder core outcome set. Hum Reprod. 2020;35(2):404-412. - PubMed

Publication types