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Review
. 2022 Sep;10(9):668-680.
doi: 10.1016/S2213-8587(22)00163-2. Epub 2022 Aug 4.

Polycystic ovary syndrome

Anju E Joham  1 , Robert J Norman  2 , Elisabet Stener-Victorin  3 , Richard S Legro  4 , Stephen Franks  5 , Lisa J Moran  6 , Jacqueline Boyle  6 , Helena J Teede  7
Affiliations
Review

Polycystic ovary syndrome

Anju E Joham et al. Lancet Diabetes Endocrinol. 2022 Sep.

Erratum in

Abstract

Polycystic ovary syndrome (PCOS) affects 5-18% of women, and is a reproductive, metabolic, and psychological condition with impacts across the lifespan. The cause is complex, and includes genetic and epigenetic susceptibility, hypothalamic and ovarian dysfunction, excess androgen exposure, insulin resistance, and adiposity-related mechanisms. Diagnosis is recommended based on the 2003 Rotterdam criteria and confirmed with two of three criteria: hyperandrogenism (clinical or biochemical), irregular cycles, and polycystic ovary morphology. In adolescents, both the criteria of hyperandrogenism and irregular cycles are needed, and ovarian morphology is not included due to poor specificity. The diagnostic criteria generates four phenotypes, and clinical features are heterogeneous, with manifestations typically arising in childhood and then evolving across adolescent and adult life. Treatment involves a combination of lifestyle alterations and medical management. Lifestyle optimisation includes a healthy balanced diet and regular exercise to prevent excess weight gain, limit PCOS complications and target weight reduction when needed. Medical management options include metformin to improve insulin resistance and metabolic features, combined oral contraceptive pill for menstrual cycle regulation and hyperandrogenism, and if needed, anti-androgens for refractory hyperandrogenism. In this Review, we provide an update on the pathophysiology, diagnosis, and clinical features of PCOS, and discuss the needs and priorities of those with PCOS, including lifestyle, and medical and infertility treatment. Further we discuss the status of international evidence-based guidelines (EBG) and translation, to support patient self management, healthcare provision, and to set research priorities.

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Conflict of interest statement

Declaration of interests AEJ has received grant support from the National Health and Medical Research Council and a School of Public Health and Preventive Medicine Bridging Fellowship. She has received honoraria for educational events from Boehringer Ingelheim Pty. She receives continuing medical education allowance from Monash Health. She is a board member of the Androgen Excess and PCOS Society. RJN has received grant support from the National Health and Research Council. He has received honoraria for educational events from Merck Pty. He is Chair of the Vitamin D in PCOS and IVF board, and Chair of the Chinese Herbal Therapy and Miscarriage board. Up until June, 2020, RJN was a minor shareholder in Fertility SA. ESV was the President of Androgen Excess and PCOS Society 2018–20 and is currently board member, and from 2022 she is Chief Scientific Officer of the Society. She received support for the present manuscript from Novo Nordisk Foundation (NNF22OC0072904) via payments to Department of Physiology and Pharmacology, Karolinska Institutet. In the past 36 months she received grants from Swedish Medical Research Council (project no. 2018-02435) and Novo Nordisk Foundation (NNF19OC0056647) via payments to Department of Physiology and Pharmacology, Karolinska Institutet. RSL has received grant and research support from the National Institutes of Health, Guerbet USA, Hass Avocado Board, Penn State Clinical and Translational Science Institute, National Center for Advancing Translational Sciences, and Patty Brisben Foundation for Women's Sexual Health. He has received consulting fees from Insudd Pty, Bayer Pty, Fractyl Pty, Abbvie Pty, and Ferring Pty. He is an Honorary Professor at the National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China. He is a Member of the International Advisory Panel for International evidence-based guideline for the Assessment and management of Polycystic Ovary Syndrome (PCOS), funded by The Australian National Health and Medical Research Council (NHMRC) through the Centre for Research Excellence in Polycystic Ovary Syndrome (CREPCOS), Monash University, Melbourne, VIC, Australia. He is a Member of the Steering Committee for the Eastern Siberia PCOS Epidemiology & Phenotype study, Scientific Center of Family Health and Human Reproduction, Irkutsk, Russian Federation. He is a member of the International Advisory Panel, aiming to develop, disseminate, and implement a core outcome set for infertility. Funded by the Royal Society of New Zealand Catalyst Fund and the University of Auckland, New Zealand. He is an advisor for a metabolomic approach to redefine diagnostic criteria and classification of polycystic ovary syndrome (Principal Investigator: Prof Chi Chui Wang, Chinese University of Hong Kong), which is funded by the Research Fund, Food and Health Bureau, The Government of the Hong Kong Special Administrative Region. He is an invited speaker for: 34th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE), Barcelona, Spain; 2018 ASRM Scientific Congress in Denver, CO; 28th Brazilian Congress of Human Reproduction, Belo Horizonte, Brazil; 2019 IFFS World Congress, Shanghai, China; Annual Meeting of ACOG, Nashville, TN; 30 Años Aniversario IDIMI (Instituto de Investigaciones Materno – Infantil, Universidad de Chile); 35th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE), Vienna, Austria; PEACOCKS Biennial Meeting, Mas de Torrent, Costa Brava, Spain; 2019 Canadian Society of Endocrinology and Metabolism/Diabetes Canada Professional and Annual Meeting, Winnipeg, Manitoba; University of California at San Diego Ob/Gyn Grand Rounds, San Diego, CA; Obesity Week, Las Vegas, NV; Seminars in Obstetrics, Gynecology and Reproductive Biology; and Grand Rounds Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS; Human Reproduction Update Chinese Edition Young Editor Meeting; Obesity and Women's Health Webinar: NIH Obesity Research Task Force (ORTF) Seminar Series; Grand Rounds, Department of Ob/Gyn, Yale University School of Medicine, New Haven, CT; Grand Rounds, Division of Medical Endocrinology, Yale University School of Medicine, New Haven, CT; Dept of Ob/Gyn West Penn Hospital, Pittsburgh, PA; The Roland S Kron Annual Lecture, Department of Ob/Gyn, Medical College of Wisconsin, Milwaukee, WI; Penn State College of Medicine Emeritus Faculty Organization Spring Meeting, Penn State College of Medicine, Hershey, PA; Penn State College of Medicine, Hershey, PA; The PCOS Society of India; Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA; and Penn State College of Medicine, Hershey, PA. RSL is a member of the medical/scientific Advisory Board for PCOS Challenge (a patient support group). He is an executive committee member for the Endocrine Society, for whom he has also been the Secretary-Treasurer. He is Chair of the Data Monitoring Committee, The Fertility, IVF and Intrauterine Insemination trial in couples with uneXplained infertility (the FIIX study). He was Co-Editor in Chief, Seminars in Reproductive Medicine; Associate Editor, Human Reproduction Update; Associate Editor, Fertility and Sterility; Editorial Board, Endocrinology; and is currently the Editorial Editor for Fertility and Sterility; Associate Editor for Global Reproductive Health; and Editorial Board, Endocrinology, 2016–19. He owns 1000 shares of Biodesix (BDSX). He is involved with the NIH: ZHD1 DSR-K (LR) 1 Loan Repayment Program (annually, 2008 to present); U54 Contraceptive Center Grant, Special Emphasis Panel ZHD1 DSR – L50 (2017); Special Emphasis Panel/Scientific Review Group 05 CHHD-W 1 Population Sciences Subcommittee (2018); and Special Emphasis Panel/Scientific Review Group 10 ZHD1 DSR-M: National Centers for Translational Research in Reproduction and Infertility (2020). He is also involved with the Kuwait Foundation for the Advancement of Science (KFAS) (2017), Appalachian Translational Research Network (ATRN) (2018), and Karolinska Institute, Stockholm, Sweden (2020). SF receives grant support from the Medical Research Council. He is a Medical Advisor to Verity (UK PCOS patient support group) for more than 10 years. LJM receives grant support from the National Heart Foundation of Australia and National Health and Medical Research Council. She is also the Convenor of Dietitians Australia Discussion Group in PCOS (continuing professional development group). JB has received grant support from the National Health and Medical Research Council and WHiRL. She is the Director on the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Foundation (unpaid), and a member of the migrant and refugee health partnership council (unpaid). HJT receives grant support from the National Health and Medical Research Council.

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