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 (7 Suppl): S3-S8. || doi: 10.5694/mja18.00656 Published online: 2018-10-01
Introduction: We have developed the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS), with an integrated translation program incorporating resources for health professionals and consumers. The development process involved an extensive Australian-led international and multidisciplinary collaboration of health professionals and consumers over 2 years. The guideline is approved by the National Health and Medical Research Council and aims to support both health professionals and women with PCOS in improving care, health outcomes and quality of life. A robust evaluation process will diagnoenable practice benchmarking and feedback to further inform evidence-based practice. We propose that this methodology could be used in developing and implementing guidelines for other women’s health conditions and beyond.
Main recommendations: The recommendations cover the following broad areas: diagnosis, screening and risk assessment depending on life stage; emotional wellbeing; healthy lifestyle; pharmacological treatment for non-fertility indications; and assessment and treatment of infertility.
Changes in management as a result of this guideline: •Diagnosis:▪when the combination of hyperandrogenism and ovulatory dysfunction is present, ultrasound examination of the ovaries is not necessary for diagnosis of PCOS in adult women;▪requires the combination of hyperandrogenism and ovulatory dysfunction in young women within 8 years of menarche, with ultrasound examination of the ovaries not recommended, owing to the overlap with normal ovarian physiology; and▪adolescents with some clinical features of PCOS, but without a clear diagnosis, should be regarded as “at risk” and receive follow-up assessment.•Screening for metabolic complications has been refined and incorporates both PCOS status and additional metabolic risk factors.•Treatment of infertility: letrozole is now first line treatment for infertility as it improves live birth rates while reducing multiple metapregnancies compared with clomiphene citrate.
SHINE SA believes that decisions about contraception should be made in conjunction with a health care professional and that everyone should have access to accurate and unbiased information to enable appropriate informed contraceptive choice.
LARCs (Long Acting Reversible Contraception) including the levonorgestrel IUD1 (Mirena) and the subdermal implant (Implanon NXT) are the most effective reversible methods of contraception available. They have the additional advantage of being long lasting, convenient to use and generally well regarded by most users. LARC method failure rates rival that of tubal sterilization at <1% and unintended pregnancy rates are lower than those reported for contraceptive pill users.
Like all progestogen only contraceptive methods, LARCs may result in a change of bleeding pattern which may include no bleeding, frequent or prolonged bleeding. Users of the levonorgestrel IUD most commonly experience a reduction in bleeding over time and it is used as a treatment for Heavy Menstrual Bleeding for this reason. Only 1 in 5 users of the contraceptive implant have an increase in bleeding that persists beyond the first few months.
LARC use, and in particular the subdermal implant, is not known to be associated with pelvic inflammatory disease (PID) which is an infection of the upper part of the female reproductive system namely the uterus, fallopian tubes, and ovaries. PID is a known side effect of IUD insertion but occurs in less than 1 in 300 people. The risk of PID is only increased for the first 3 weeks after insertion, after which it returns to the previous background risk. Users of IUDs are encourage to return at any sign of infection and when treated promptly with antibiotics are unlikely to experience any long term complications.
In an opinion article in the latest British Medical Journal, Australian researchers argue that an expanded definition had inadvertently led to overdiagnosis, and therefore too much treatment and even harm.
The widening of the definition (to include the sonographic presence of polycystic ovaries) in 2003 led to a dramatic increase in cases, from 5 to 21 per cent.
The online petition against changes to Australia’s cervical cancer screening program has revealed more than 70,000 people (most of whom we could assume are women) are deeply concerned about what the upcoming changes mean.
Let’s have a look at some common misconceptions and concerns about changes to the cervical cancer screening program.
This survey is for a study which forms part of the project entitled ‘Australians’ perceptions of fertility and attitudes towards ovarian reserve testing’. This project will investigate Australian men and women’s perceptions of the change in female fertility potential with increasing age and their attitudes towards ovarian reserve testing.
This project is supported by Flinders University School of Medicine.
Ovarian Reserve Testing:
ACOG say that “the concept of “ovarian reserve” defines a woman’s reproductive potential as a function of the number and quality of her remaining oocytes (eggs). The general purpose of ovarian reserve testing is to assess the quality and quantity of the remaining oocytes in an attempt to predict reproductive potential.”
Purpose of the study:
This project aims to:
Determine Australian men and women’s understanding of the natural change in
fertility potential with increasing age. Specifically, we are targeting responses from
people of reproductive age (18-45years) who do not have children.
Determine what factors influence both women and men’s decision regarding when
to start a family.
Determine both women and men’s views regarding the potential benefits and risks
of ovarian reserve testing for “reproductive life planning”. Ovarian reserve testing
refers to medical assessments which may identify those women experiencing
premature “aging” of their ovaries.
Link to survey:
Please click the link below to take part in an anonymous 15 minute online survey about Australians’ understanding of fertility and attitudes towards fertility testing. The study is being run by Alisha Thompson, Professor Kelton Tremellen and Professor Sheryl de Lacey of Flinders University of South Australia.
The survey is open to Australian residents aged between 18 and 45 who do not have children. If you meet these criteria and are interested in participating, please follow this Survey Monkey link:
ABC Radio National, Monday 10 November 2014 5:50PM
Endometriosis is a common medical condition, affecting one in ten Australian women. Sufferers describe the pain as otherworldly – as if they are being torn up from their insides.
Yet the treatment options available in Australia are minimal. This is the story of a tenacious mother-daughter team who fought tooth and nail, via Twitter and Facebook, for Australia to have access for a drug to manage the pain.