045 International guideline and collaborative research

Abstract

Background: Diagnosis of polycystic ovary syndrome (PCOS) during adolescence is controversial with adult diagnostic criteria overlapping with normal pubertal physiological events. Recent international evidence-based guidelines aimed to promote accurate diagnosis, optimal consistent care, prevention of complications and improved health outcomes. Methods: Extensive international collaboration, health professional and consumer engagement informed guideline priorities. International nominated panels including those with PCOS, multidisciplinary health professionals (across 38 societies and 71 countries), researchers and an evidence synthesis team. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied on evidence quality, feasibility, acceptability, cost, implementation and recommendation strength. Results: We provided 166 recommendations (15 for adolescents). Adolescent clinical consensus recommendations for PCOS diagnosis aimed to avoid misdiagnosis, delayed and under diagnosis and over diagnosis and will be discussed here. Importantly, pelvic ultrasound and Anti-Mullerian Hormone measurement are not recommended for adolescent diagnosis. For adolescents, who have features of PCOS, but do not meet diagnostic criteria, an “increased risk” could be considered and reassessment advised at or before 8 years post menarche. Exclusion of other relevant disorders is required. Adolescent evidence-based recommendations for PCOS pharmacological treatment will also be discussed. Research priorities were established and updated adolescent diagnostic criteria were subsequently evaluated in a longitudinal cohort with results endorsing guideline recommendations. Conclusions: Extensive international engagement and rigorous processes have refined diagnostic criteria and clarified treatment of PCOS in adolescence and highlighted vital research gaps.