The ACOG noted that a universally accepted definition of PCOS is lacking. As proposed by the National Institutes of Health (NIH), the diagnostic. Among the ACOG recommendations and conclusions, including the update on the use of letrozole, for the management of PCOS. The major features of polycystic ovarian syndrome (PCOS) include menstrual dysfunction, anovulation, and signs of hyperandrogenism.

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Combined hormonal birth control pills can be used for long-term treatment in women with PCOS who do not wish to become pregnant. Few studies support the benefits of a high-protein diet for women with PCOS, and there are concerns about the adverse effects that the diet has on renal function and lipids. Women with coexisting signs of Cushing’s syndrome e. To see the full article, log in or purchase access. The information does not dictate an exclusive course of treatment or procedure to be followed and should scog be construed as excluding other acceptable methods of practice.

A hormone that lowers the levels of glucose sugar in the blood. Irregular menstrual periods can lead to infertility and, in some women, the development of numerous small fluid-filled sacs in the ovaries. Multiple electrolysis or laser treatments may be needed.

ACOG Practice Bulletin No. Polycystic Ovary Syndrome.

Already a member or subscriber? Polycystic Ovary Syndrome and Risk of Type 2 Diabetes The ACOG recommends that because of demonstrated increased risk, all women with PCOS should be screened for type 2 diabetes and glucose intolerance with a fasting glucose level followed by a two-hour glucose level obtained after a g glucose load recommendation based on good and consistent scientific evidence.

This may cause more insulin to be produced as the body tries to move glucose into cells. See My Options close. The ACOG recommends that all women suspected of having PCOS be screened with a hydroxyprogesterone level recommendation based on consensus and expert opinion. The Diabetes Prevention program has found that in women with impaired glucose tolerance, the risk of diabetes can be reduced significantly with the use of lifestyle interventions and metformin an insulin-sensitizing agent.


Drug class differences exist, with thiazolidinediones tending to increase weight and biguanides tending to decrease weight; risk-benefit ratios and effects for individual agents also differ. If you have further questions, contact your obstetrician—gynecologist.

Approximately 4 to 6 percent of women have hyperandrogenic chronic anovulation. Weight loss also has been found to improve cholesterol and insulin levels and relieve symptoms such as excess hair growth and acne. In women with PCOS who use metformin, glucose tolerance improves or remains steady over time. When this agent is used in women with PCOS, about 80 percent ovulate and one half of these patients conceive.

Read the full article. Insulin resistance can lead to diabetes mellitus.

ACOG Releases Guidelines on Diagnosis and Management of Polycystic Ovary Syndrome

Although data on the effects of exercise on PCOS are limited, the ACOG notes that it is reasonable to assume that an exercise program even without weight loss would have positive effects.

These birth control pills regulate the menstrual cycle and reduce hirsutism and acne by decreasing androgen levels. The ACOG recommends treatment with clomiphene citrate because of its effectiveness recommendation based on good and consistent scientific evidence.

Sign up for the free AFP email table of contents. This syndrome contributes to both diabetes and heart disease. A specific type of endometrial hyperplasia may lead to cancer. Patches of thickened, velvety, darkened skin associated with insulin resistance. High androgen levels also cause the unwanted hair growth and acne seen in many women with PCOS.

Restoring ovulation helps make menstrual periods regular and more predictable. A Nonhealing Ulcer of the Hand. The ACOG notes that the optimal progestin and the optimal duration and frequency of treatment to prevent endometrial cancer in women with PCOS is not known. The etiology of PCOS remains unknown, but selective insulin resistance may be a central factor. When the body does not respond to insulin, the level of glucose in the blood increases.

Substances made in the body by cells or organs that control the function of cells or organs. Before drug therapy is used, regular exercise and weight control measures should be tried. The role of insulin-sensitizing agents in the primary or secondary prevention of cardiovascular disease in women with PCOS remains unknown. This condition increases the risk of endometrial cancer. Ovulation induction in these women is a concern because of the increased risk of ovarian hyperstimulation syndrome, pregnancy loss in the first trimester, and multiple pregnancy.


The body mass index and waist-hip ratio also should be calculated. Combined hormonal pills contain both estrogen and progestin.

The ACOG notes that interventions to improve insulin sensitivity, such as weight loss and the use of insulin-sensitizing agents, are beneficial in improving the frequency of ovulation in women with PCOS recommendation based on good and consistent scientific evidence. More in Pubmed Citation Related Articles.

Conditions associated with insulin resistance, including centripetal distribution of fat, obesity, obesity-related sleep disorders, and acanthosis nigricans, are common in women with PCOS and are risk factors for cardiovascular disease and type 2 diabetes.

Treatment is tailored to each woman according to symptoms, other health problems, and whether she wants to become pregnant. Acanthosis nigricans is a condition ;cos by velvety, mossy, verrucous, hyperpigmented skin, often noted on the back of the neck, beneath the breasts, in the axillae, or on the vulva.

Choose a single article, issue, or full-access subscription. Pco immediate access, anytime, anywhere. These drugs help the body respond to insulin. It also is associated pcis acanthosis nigricans.

Successful ovulation is the first step toward pregnancy. The smallest units of a structure in the body; the building blocks for all parts of the body. Screening for Nonclassic Congenital Adrenal Hyperplasia Adult women with anovulation and hirsutism may have nonclassic congenital adrenal hyperplasia. The guideline appeared in the December issue of Obstetrics and Gynecology. Polycystic-appearing ackg on ultrasound examination are a nonspecific finding in PCOS.