Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome

Autor: Joop S.E. Laven, Kathleen M. Hoeger, Nigel K. Stepto, Bulent O. Yildiz, Kate Marsh, Ricardo Azziz, Angelica Lindén Hirschberg, Adam H. Balen, Juha S. Tapanainen, Jane Speight, Roger Hart, Eszter Vanky, Angela Wan, Shakila Thangaratinam, Bart C.J.M. Fauser, Rong Li, Luigi Devoto, Lisa J. Moran, Leah Brennan, Edgar Mocanu, Duru Shah, Jie Qiao, Michael F. Costello, Elisabet Stener-Victorin, Darren Mansfield, Mala Thondan, Rachel Hawkes, Anju E. Joham, Jane Woolcock, Marla E. Lujan, Sasha Ottey, Rhonda Garad, Samantha K. Hutchison, Poli Mara Spritzer, Helena J. Teede, Raymond J. Rodgers, Eliza C. Tassone, Estifanos Baye, Daniela Romualdi, Leanne M. Redman, Richard S. Legro, Chii Ruey Tzeng, Veryan McAllister, Jaideep Malhotra, Stephen Franks, Frank J.M. Broekmans, Ben W.J. Mol, Preeti Dabadghao, Cheryce L. Harrison, Sharon E. Oberfield, Robert J. Norman, Terhi Piltonen, Ernest Hung Yu Ng, Selma F. Witchel, Luk Rombauts, Maria G. Vogiatzi, Louise Johnson, Marianne Andersen, Cailin Jordan, Melanie Gibson-Helm, Chandrika N Wijeyaratne, Zephne M van der Spuy, Linda Downes, Femke P Hohmann, Anuja Dokras, Jayashri Kulkarni, Alexia S Peña, Marie Misso, Didier Dewailly, Jacqueline Boyle
Přispěvatelé: Obstetrics & Gynecology, Reproductive Disease Modeling, Clinicum, Department of Obstetrics and Gynecology, HUS Gynecology and Obstetrics, Çocuk Sağlığı ve Hastalıkları
Rok vydání: 2018
Předmět:
Internationality
Endocrinology
Diabetes and Metabolism
assessment
Evidence-Based Medicine/methods
Guideline
Endocrinology
PHYSICIANS
0302 clinical medicine
Risk Factors
Pregnancy
3123 Gynaecology and paediatrics
Health care
Obstetrics and Gynaecology
PCOS
030212 general & internal medicine
Disease management (health)
Polycystic ovary syndrome
Evidence-Based Medicine
030219 obstetrics & reproductive medicine
Rehabilitation
WOMEN
Disease Management
Obstetrics and Gynecology
Polycystic ovary
ESHRE Pages
Management
3. Good health
Diabetes and Metabolism
GRADE
Practice Guidelines as Topic
Professional association
Female
Psychology
Infertility
Female
guideline
management
Adult
Evidence-based practice
Adolescent
Best practice
DIAGNOSTIC-CRITERIA
SOCIETY
Polycystic Ovary Syndrome/complications
030209 endocrinology & metabolism
Assessment
Article
Young Adult
03 medical and health sciences
Quality of life (healthcare)
evidence-based
Infertility
Female/etiology
Humans
Medical education
business.industry
Australia
Reproductive Medicine
polycystic ovary syndrome
HEALTH-CARE
Quality of Life
business
Evidence-based
Zdroj: Human Reproduction, 33(9), 1602. Oxford University Press
Fertility & Sterility, 110(3), 364-379. Elsevier Inc.
Fertility and sterility
Clinical Endocrinology, 89(3), 251. Wiley-Blackwell
International PCOS Network & Skovsager Andersen, M 2018, ' Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome ', Human reproduction (Oxford, England), vol. 33, no. 9, pp. 1602-1618 . https://doi.org/10.1093/humrep/dey256
Clinical Endocrinology, 89(3), 251-268. Wiley-Blackwell Publishing Ltd
Human Reproduction, 33(9), 1602-1618. Oxford University Press
Andersen, M & International PCOS Network 2018, ' Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome ', Clinical Endocrinology, vol. 89, no. 3, pp. 251-268 . https://doi.org/10.1111/cen.13795
Human Reproduction (Oxford, England)
ISSN: 0015-0282
0268-1161
0300-0664
Popis: STUDY QUESTION: What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise and consumer preference?SUMMARY ANSWER: International evidence-based guidelines, including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS.WHAT IS KNOWN ALREADY: Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial, and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist.STUDY DESIGN, SIZE, DURATION: International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength.PARTICIPANTS/MATERIALS, SETTING, METHODS: Governance included a six continent international advisory and a project board, five guideline development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis and translation experts. In total, 37 societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels.MAIN RESULTS AND THE ROLE OF CHANCE: The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: (i) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; (ii) reducing unnecessary testing; (iii) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and (iv) emphasizing evidence based medical therapy and cheaper and safer fertility management.LIMITATIONS, REASONS FOR CAUTION: Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided.WIDER IMPLICATIONS OF THE FINDINGS: The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program.STUDY FUNDING/COMPETING INTEREST(S): The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine. Guideline development group members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of conflicts declared across the guideline development groups are available at https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline in the Register of disclosures of interest. Of named authors, Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Laven declared grants from Ferring, Euroscreen and personal fees from Ferring, Euroscreen, Danone and Titus Healthcare. Prof. Norman has declared a minor shareholder interest in an IVF unit. The remaining authors have no conflicts of interest to declare. The guideline was peer reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREE-II criteria, and underwent methodological review. This guideline was approved by all members of the guideline development groups and was submitted for final approval by the NHMRC.
Databáze: OpenAIRE
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