Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.
Level 1 - systematic review of randomized trials
Evidence-based clinical practice guideline based on 52 systematic reviews and 3 narrative reviews using AGREE II and GRADE frameworks
PubMed 37580314 · doi:10.1210/clinem/dgad463
What was done
An international guideline development network involving 39 professional and consumer organizations across 71 countries updated the 2018 polycystic ovary syndrome (PCOS) guidelines using AGREE II and GRADE frameworks. Over 12 months, multidisciplinary panels and consumer representatives addressed 58 prioritized clinical questions supported by 52 systematic reviews and 3 narrative reviews to produce evidence-based and consensus recommendations.
What was found
The process generated 254 total statements, comprising 77 evidence-based recommendations, 54 consensus recommendations, and 123 practice points. Key updates include incorporating anti-Müllerian hormone (AMH) as an alternative to ultrasound in adults, refining diagnostic algorithms, broadening recognition of metabolic, cardiovascular, sleep apnea, psychological, and adverse pregnancy risks, addressing weight stigma and emotional wellbeing, and defining evidence-based medical therapy and lower-cost, safer fertility management. The underlying evidence base improved compared to 2018 but remains generally low to moderate in quality.
Why it matters
This guideline updates global standards for PCOS diagnosis and management, standardizing care pathways and reducing diagnostic delays across primary, endocrine, and reproductive healthcare settings internationally.
Limits
The abstract notes that the underlying evidence across clinical questions remains predominantly low to moderate quality. Specific numerical effect sizes, diagnostic thresholds (such as cutoff values for AMH), and drug-specific outcomes are not reported in the abstract. Implementation and applicability are subject to regional health system variations.
Cited by
- supports The diagnostic criteria for PCOS require meeting at least two out of three criteria: hyperandrogenism symptoms/elevated androgens, ovulatory dysfunction/irregular periods, and polycystic ovarian morphology on ultrasound or elevated AMH.
- supports In 2023, updated international clinical guidelines added elevated anti-Müllerian hormone (AMH) as an alternative diagnostic marker to polycystic ovarian morphology on ultrasound for PCOS.