Consensus on women's health aspects of polycystic ovary syndrome (PCOS).

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in females with a high prevalence. The etiology of this heterogeneous condition remains obscure and its phenotype expression varies. Two, widely cited, previous ESHRE/ASRM-sponsored PCOS consensus workshops focused on diagnosis (published in 2004) and infertility management (published in 2008). The present third PCOS consensus paper summarizes current knowledge and identifies knowledge gaps regarding various women's health aspects of PCOS. Relevant topics addressed-all dealt with in a systematic fashion-include adolescence, hirsutism and acne, contraception, menstrual cycle abnormalities, quality of life, ethnicity, pregnancy complications, long-term metabolic and cardiovascular health and finally cancer risk. Additional, comprehensive background information is provided separately in an extended online publication.

[1]  M. Eijkemans,et al.  New Approach to Polycystic Ovary Syndrome and Other Forms of Anovulatory Infertility , 2002, Obstetrical & gynecological survey.

[2]  T. Wilkin,et al.  The central issue? Visceral fat mass is a good marker of insulin resistance and metabolic disturbance in women with polycystic ovary syndrome , 2006, BJOG : an international journal of obstetrics and gynaecology.

[3]  D. Apter.  Endocrine and Metabolic Abnormalities in Adolescents with a PCOS-like Condition: Consequences for Adult Reproduction , 1998, Trends in Endocrinology & Metabolism.

[4]  S. Wild,et al.  Mortality of women with polycystic ovary syndrome at long-term follow-up. , 1998, Journal of clinical epidemiology.

[5]  N. Johnson,et al.  Metformin versus oral contraceptive pill in polycystic ovary syndrome: a Cochrane review. , 2007, Human reproduction.

[6]  J. Balfour,et al.  Topical Eflornithine , 2001, American Journal of Clinical Dermatology.

[7]  M. Eijkemans,et al.  Changes in anti-Müllerian hormone serum concentrations over time suggest delayed ovarian ageing in normogonadotrophic anovulatory infertility. , 2004, Human reproduction.

[8]  R. Cífková,et al.  Increased risk of non-insulin dependent diabetes mellitus, arterial hypertension and coronary artery disease in perimenopausal women with a history of the polycystic ovary syndrome. , 2000, Human reproduction.

[9]  Rakesh K. Gupta,et al.  Abdominal fat distribution and insulin resistance in Indian women with polycystic ovarian syndrome. , 2009, Fertility and sterility.

[10]  V. Padmanabhan,et al.  Polycystic Ovary Syndrome and Oocyte Developmental Competence , 2008, Obstetrical & gynecological survey.

[11]  A. Tosti,et al.  Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: a randomized, double blind, placebo-controlled trial. , 2000, The Journal of clinical endocrinology and metabolism.

[12]  E. Porcu,et al.  Longitudinal Change of Sonographic Ovarian Aspects and Endocrine Parameters in Irregular Cycles of Adolescence , 1995, Pediatric Research.

[13]  C. Welt,et al.  Criteria for polycystic ovarian morphology in polycystic ovary syndrome as a function of age. , 2009, The Journal of clinical endocrinology and metabolism.

[14]  G. Guyatt,et al.  Development of a health-related quality-of-life questionnaire (PCOSQ) for women with polycystic ovary syndrome (PCOS). , 1998, The Journal of clinical endocrinology and metabolism.

[15]  N. Sattar,et al.  Metformin or antiandrogen in the treatment of hirsutism in polycystic ovary syndrome. , 2003, The Journal of clinical endocrinology and metabolism.

[16]  R. Lobo,et al.  The diagnosis of polycystic ovary syndrome in adolescents. , 2010, American journal of obstetrics and gynecology.

[17]  E. Barrett-Connor,et al.  Searching for polycystic ovary syndrome in postmenopausal women: evidence of a dose-effect association with prevalent cardiovascular disease , 2007, Menopause.

[18]  W. Dodson,et al.  Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype , 2005 .

[19]  Dongzi Yang,et al.  Association of biochemical hyperandrogenism with type 2 diabetes and obesity in Chinese women with polycystic ovary syndrome , 2010, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[20]  M. Solaymani-Dodaran,et al.  Is polycystic ovary syndrome an exception for reproductive aging? , 2010, Human reproduction.

[21]  A. Dunaif,et al.  Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. , 1997, Endocrine reviews.

[22]  R. Hirasing,et al.  Predictive value of menstrual cycle pattern, body mass index, hormone levels and polycystic ovaries at age 15 years for oligo-amenorrhoea at age 18 years. , 2004, Human reproduction.

[23]  K. Hill.  LONG-TERM CONSEQUENCES , 2004 .

[24]  J. Manson,et al.  Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. , 2001, JAMA.

[25]  R. Seneviratne,et al.  Phenotype and metabolic profile of South Asian women with polycystic ovary syndrome (PCOS): results of a large database from a specialist Endocrine Clinic. , 2011, Human reproduction.

[26]  L. Moran,et al.  Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. , 2010, Human reproduction update.

[27]  L. Moran,et al.  Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. , 2009, Fertility and sterility.

[28]  B. Fauser,et al.  Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). , 2004, Human reproduction.

[29]  C. Wijeyaratne,et al.  A simple screening approach for assessing community prevalence and phenotype of polycystic ovary syndrome in a semi-urban population in Sri Lanka. , 2008, American journal of epidemiology.

[30]  M. McCarthy,et al.  Metabolic characteristics of women with polycystic ovaries and oligo‐amenorrhoea but normal androgen levels: implications for the management of polycystic ovary syndrome , 2007, Clinical endocrinology.

[31]  T. Vutyavanich,et al.  Clinical, endocrine and ultrasonographic features of polycystic ovary syndrome in Thai women , 2007, The journal of obstetrics and gynaecology research.

[32]  R. Norman,et al.  Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. , 2010, The Cochrane database of systematic reviews.

[33]  Dongzi Yang,et al.  Appropriate BMI levels for PCOS patients in Southern China. , 2010, Human reproduction.

[34]  S. Johansson,et al.  Women With Polycystic Ovary Syndrome Wedge Resected in 1956 to 1965: A Long-Term Follow-up Focusing on Natural History and Circulating Hormones , 1993 .

[35]  S. Johansson,et al.  Women with polycystic ovary syndrome wedge resected in 1956 to 1965: A long‐term follow‐up focusing on natural history and circulating hormones , 1992 .

[36]  S. Franks.  When should an insulin sensitizing agent be used in the treatment of polycystic ovary syndrome? , 2011, Clinical endocrinology.

[37]  D. Goulis,et al.  Consensus on infertility treatment related to polycystic ovary syndrome , 2008 .

[38]  J. Schildkraut,et al.  Epithelial Ovarian Cancer Risk Among Women With Polycystic Ovary Syndrome , 1996, Obstetrics and gynecology.

[39]  C. Glueck,et al.  Obesity and extreme obesity, manifest by ages 20-24 years, continuing through 32-41 years in women, should alert physicians to the diagnostic likelihood of polycystic ovary syndrome as a reversible underlying endocrinopathy. , 2005, European journal of obstetrics, gynecology, and reproductive biology.

[40]  V. Burke,et al.  Quality of life and psychological morbidity in women with polycystic ovary syndrome: body mass index, age and the provision of patient information are significant modifiers , 2007, Clinical endocrinology.

[41]  M. Olovsson,et al.  Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve. , 2009, Human reproduction.

[42]  D. Kurtz,et al.  Insulin Sensitizers for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials , 2008 .

[43]  S. Davis,et al.  Androgen levels in adult females: changes with age, menopause, and oophorectomy. , 2005, The Journal of clinical endocrinology and metabolism.

[44]  A. Go,et al.  Epidemiology and adverse cardiovascular risk profile of diagnosed polycystic ovary syndrome. , 2006, The Journal of clinical endocrinology and metabolism.

[45]  M. Himelein,et al.  Polycystic Ovary Syndrome and Mental Health: A Review , 2006, Obstetrical & gynecological survey.

[46]  M. Eijkemans,et al.  A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. , 2006, Human reproduction update.

[47]  D. Barad,et al.  Lack of association between polycystic ovary syndrome and embryonic aneuploidy. , 2007, Fertility and sterility.

[48]  J. Hall,et al.  Health-related quality of life measurement in women with polycystic ovary syndrome: a systematic review. , 2007, Human reproduction update.

[49]  J. Marshall,et al.  Polycystic Ovary Syndrome in Adolescence , 2008, Annals of the New York Academy of Sciences.

[50]  S. Bhattacharya,et al.  Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. , 2009, Reproductive biomedicine online.

[51]  J. Dungan.  Metformin Versus Placebo from First Trimester to Delivery in Polycystic Ovary Syndrome: A Randomized, Controlled Multicenter Study , 2011 .

[52]  M. Byrne,et al.  Insulin secretory defects in polycystic ovary syndrome. Relationship to insulin sensitivity and family history of non-insulin-dependent diabetes mellitus. , 1995, The Journal of clinical investigation.

[53]  P. McKeigue,et al.  Long-term consequences of polycystic ovary syndrome: Results of a 31 year follow-up study , 2000, Human fertility.

[54]  S. Reis,et al.  Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health--National Heart, Lung, and Blood Institute sponsored Women's Ischemia Syndrome Evaluation. , 2008, The Journal of clinical endocrinology and metabolism.

[55]  Huiying Yang,et al.  Polycystic ovary syndrome in Mexican-Americans: prevalence and association with the severity of insulin resistance. , 2005, Fertility and sterility.

[56]  A. Dokras,et al.  Increased Risk for Abnormal Depression Scores in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis , 2011, Obstetrics and gynecology.

[57]  P. Claman.  Men at risk: occupation and male infertility. , 2004, Fertility and sterility.

[58]  J. Schoemaker,et al.  Obesity, rather than menstrual cycle pattern or follicle cohort size, determines hyperinsulinaemia, dyslipidaemia and hypertension in ageing women with polycystic ovary syndrome , 2001, Clinical endocrinology.

[59]  M. Erenus,et al.  Comparison of finasteride versus spironolactone in the treatment of idiopathic hirsutism , 1997 .

[60]  G. Jerums,et al.  Comparison of sequential cyproterone acetate/estrogen versus spironolactone/oral contraceptive in the treatment of hirsutism. , 1991, The Journal of clinical endocrinology and metabolism.

[61]  B. Yıldız,et al.  Oral contraceptives in polycystic ovary syndrome: risk-benefit assessment. , 2008, Seminars in reproductive medicine.