Polycystic Ovary Syndrome

Aya Mousa, PhD, BHSc (Hons-I)

Anju Joham, MBBS, FRACP, PhD

Jacqueline Boyle, MBBS, FRANZCOG, MPH & TM, PhD

Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 8–13% of reproductive age women worldwide and up to 21% of Aboriginal and Torres Strait Islander (Indigenous) women in Australia.[1] [2] [3] Hyperandrogenism and insulin resistance are key pathological determinants, influenced by genetic predisposition, in utero hormonal exposures, obesity, and lifestyle and environmental factors.[4] [5] Obtaining a timely PCOS diagnosis can be challenging, with many women experiencing significant delays, inadequate or conflicting information, and overall poor satisfaction with care, especially in areas such as psychological and psychosexual health, lifestyle management, and prevention. Over-diagnosis can also be problematic, including when polycystic ovarian morphology on ultrasound is incorrectly used as the single criterion equated with PCOS.[6] Clinically, treatments for PCOS tend to focus on specific aspects such as infertility, whereas current evidence signals a need to shift this focus toward a more holistic, person-centered approach to managing PCOS and its broader complications. The importance of timely, accurate diagnosis; provision of appropriate, tailored information; and recognition of the heterogeneous and often simultaneous biopsychosocial symptoms of PCOS, cannot be underestimated.

In this issue, we discuss the diagnosis and prevalence of PCOS, including reviewing the diagnostic recommendations from the international evidence-based guidelines,[7] as well as the prevalence of PCOS and associated features and complications among Indigenous women globally. We describe new advances in the epidemiology of PCOS and the potential for novel biomarkers such as metabolomics to aid in diagnosis and management. The relationships between PCOS and pre-gestational or gestational diabetes in pregnancy are also discussed, with reference to the impact of these metabolic conditions on breastmilk composition and lactogenesis. We examine current treatments of PCOS, with emphasis on lifestyle management in clinical practice. The main barriers and recommendations to improve lifestyle management are presented, focusing on behavior change and integrated models of care. Finally, the PCOS research and guideline translation program is evaluated with recommendations for future directions to accelerate the delivery of consistent, evidence-based care. The articles in this issue target some of the gaps identified in the international guidelines,[7] in the hope of expanding the current evidence base and providing a valuable resource to clinicians and scientists in this field. We hope that these articles shed new insights on the diagnosis, prevalence, epidemiology and treatment of PCOS to improve PCOS screening and management for current and future generations.

Publication History

Article published online:
16 September 2021

• References

• 1 Boyle JA, Cunningham J, O'Dea K, Dunbar T, Norman RJ. Prevalence of polycystic ovary syndrome in a sample of Indigenous women in Darwin, Australia. Med J Aust 2012; 196 (01) 62-66
• 2 March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010; 25 (02) 544-551
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• 4 Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012; 33 (06) 981-1030
• 5 Tata B, Mimouni NEH, Barbotin AL. et al. Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood. Nat Med 2018; 24 (06) 834-846
• 6 Teede HJMM, Misso ML, Boyle JA. et al; International PCOS Network. Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Med J Aust 2018; 209 (S7): S3-S8
• 7 Teede HJ, Misso ML, Costello MF. et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018; 33 (09) 1602-1618