Pcos92 Case Study

RCOG GUIDELINES ON PCOS92

PCOS should be diagnosed according to the Rotterdam consensus criteria. Women diagnosed with PCOS should be informed of the possible long-term risks to health that are associated with their condition by their healthcare professional. Clinicians may consider offering screening for gestational diabetes to women who have been diagnosed as having PCOS before pregnancy. This should be performed at 24–28 weeks of gestation, with referral to a specialist obstetric diabetic service if abnormalities are detected. Women presenting with PCOS who are overweight (body mass index [BMI] ≥ 25 kg/m2) and women with PCOS who are not overweight (BMI < 25 kg/m2), but who have additional risk factors such as advanced age (> 40 years),

Clinicians need to be aware that conventional cardiovascular risk calculators have not been validated in women with PCOS. All women with PCOS should be assessed for CVD risk by assessing individual CVD risk factors (obesity, lack of physical activity, cigarette smoking, family history of type II diabetes, dyslipidaemia, hypertension, impaired glucose tolerance, type II diabetes) at the time of initial diagnosis. In clinical practice, hypertension should be treated; however, lipid-lowering treatment is not recommended routinely and should only be prescribed by a specialist. Psychological issues should be considered in all women with PCOS. Depression and/or anxiety should be routinely screened for and, if present, assessed. If a woman with PCOS is positive on screening, further assessment and appropriate counselling and intervention should be offered by a qualified

Insulin-sensitising agents have not been licensed in the UK for use in patients without diabetes. Although a body of evidence has accumulated demonstrating the safety of these drugs, there is currently no evidence that the use of insulin-sensitising agents confers any long-term benefit. Use of weight reduction drugs may be helpful in reducing hyperandrogenaemia. Ovarian electrocautery should be considered for selected anovulatory patients, especially those with a normal BMI, as an alternative to ovulation induction. Bariatric surgery may be an option for morbidly obese women with PCOS (BMI of 40 kg/m2 or more or 35 kg/m2 or more with a high-risk obesity-related condition) if standard weight loss strategies have