AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ANDROGEN EXCESS AND PCOS SOCIETY DISEASE STATE CLINICAL REVIEW: GUIDE TO THE BEST PRACTICES IN THE EVALUATION AND TREATMENT OF POLYCYSTIC OVARY SYNDROME - PART 2.
Level 5 - mechanism / opinion, no new human data
Clinical practice guideline and narrative disease state clinical review without systematic review methodology
PubMed 26642102 · doi:10.4158/EP15748.DSCPT2
What was done
A joint disease state clinical review and best practices guide developed by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE), and the Androgen Excess and PCOS Society (AES) evaluating the metabolic, cardiovascular, dermatologic, and reproductive aspects of polycystic ovary syndrome (PCOS).
What was found
In obese women with PCOS, impaired glucose tolerance (IGT) occurs in 31% to 35% and type 2 diabetes mellitus (T2DM) in 7.5% to 10%, with progression rates to IGT/T2DM reaching 5% to 15% over 3 years. Young, lean PCOS patients display atherogenic lipid profiles (reduced HDL size, elevated VLDL and LDL particle numbers). Statins decrease testosterone, total cholesterol, and LDL cholesterol, but show no effect on menses, spontaneous ovulation, hirsutism, acne, HDL, C-reactive protein, or insulin resistance measures. Baseline venous thromboembolism risk is 1.5-fold higher in PCOS, increasing to 3.7-fold with oral contraceptive use. A weight loss of 5% can restore regular menses and improve ovulation response. Oral agents (clomiphene citrate or letrozole) are recommended as first-line treatment for anovulatory infertility.
Why it matters
This guideline clarifies cardiometabolic surveillance protocols—such as routine oral glucose tolerance testing every 1 to 2 years—and standardizes the stepwise management of fertility and metabolic risks in women with PCOS.
Limits
The abstract describes a narrative guideline without detailing systematic review methodology, search strategies, or study quality gradings. The authors explicitly note limited clinical trial data demonstrating clear benefits for preconceptional weight loss recommendations, as well as an absence of long-term studies on statins and hard cardiovascular event outcomes in PCOS.
Cited by
- context In patients with PCOS who have regular menstrual cycles, bleeding is frequently caused by estrogen withdrawal rather than progesterone production following ovulation.