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Polycystic ovary syndrome - Management
Overview of management
- Encourage a healthy lifestyle to reduce possible long-term risks to health (Type 2 diabetes and cardiovascular disease). Emphasize that becoming overweight makes the condition worse.
- Offer screening for impaired glucose tolerance and Type 2 diabetes annually.
- Do not initiate treatment with insulin-sensitizing drugs in primary care.
- Refer the woman if this treatment is being considered.
- Offer regular screening for cardiovascular risk factors.
- Advise measures to reduce cardiovascular risk.
- Refer the woman for specialist advice if glucose intolerance is present or if dyslipidaemia requires treatment.
- Ask about snoring and daytime fatigue/somnolence.
- Refer for investigation and treatment if there are symptoms of obstructive sleep apnoea.
- For women who are overweight, advise weight loss.
- For women with oligomenorrhoea or amenorrhoea:
- Induce a withdrawal bleed and then refer for ultrasonography to assess endometrial thickness.
- If the endometrium fails to shed, endometrial thickening is present (greater than 10 mm), or the endometrium has an unusual appearance, refer for endometrial sampling to exclude endometrial hyperplasia or cancer.
- If the endometrium is of normal thickness, advise treatment to prevent endometrial hyperplasia. Offer women the choice of either regular withdrawal bleeding at least once every 3 months (using a combined oral contraceptive or cyclical progestogen) or the levonorgestrel intrauterine system.
- For women with hirsutism, offer advice about cosmetic measures and consider treatment with:
- A standard combined oral contraceptive or co-cyprindiol (Dianette®), or
- Topical eflornithine if hormonal treatment is contraindicated, ineffective, or inappropriate.
- For women with infertility:
- Carry out an assessment to identify the possible causes of infertility, which might not be due to polycystic ovary syndrome.
- Strongly advise the woman to lose weight, if appropriate.
- Consider referring to secondary care for fertility treatment.
- For women who are pregnant:
- Screen for gestational diabetes and impaired glucose tolerance with an oral glucose tolerance test before 20 weeks' gestation.
- Refer to a specialist obstetric diabetic service if abnormalities are detected.
- Be aware that there is an increased risk of pregnancy-induced hypertension, pre-eclampsia, and pre-term birth.
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