Summary

PCOS is common and is a major health and economic burden. It is associated with psychological, reproductive and metabolic features and in most cases is underpinned by insulin resistance. It is a chronic disease, with manifestations across the lifespan and is best managed in primary care with specialist involvement where needed.

Management should focus on support, education, addressing psychological factors and strongly emphasising healthy lifestyle, with targeted medical therapy as required. Along with managing reprodcutive complications, monitoring for and managing longer-term metabolic complications, including glucose intolerance, diabetes, cardiovascular risk factors and hyperlipidaemia, is important. Consideration should also be given to screening family members for metabolic abnormalities.   

Key points

• PCOS is a chronic complex condition with psychological, reproductive and metabolic features.
• Women with PCOS have a high risk of metabolic syndrome, prediabetes and diabetes.
• Screening for metabolic features, including a lipid profile and an OGTT, is needed regularly to detect prediabetes when progression to diabetes is still preventable (fasting glucose levels are not adequate).
• Treatment for most patients is lifestyle focused and, while medical therapy can support ifestyle change, an aggressive, lifestyle-based multidisciplinary approach is optimal in most cases to manage the features of PCOS and prevent long-term complications.
• Small achievable goals of 5% loss of body weight or moderate exercise three times a week results in significant clinical improvement even if women remain clinically in the overweight or obese range (BMI >25kg/m2).

Professoer Helena Teede

Director of research, Jean Hailes Foundation for Women’s Health, Clayton, school of public health, Monash University, Melbourne, and head of Diabetes Southern Health, Melbourne, Victoria. 

Dr Lisa Moran 

Senior research fellow and dietitian, Jean Hailes Foundation for Women’s Health, Clayton and school of public health, Monash University, Melbourne, Victoria. 

Dr Amanda Deeks

Deputy director of research and research psychologist, Jean Hailes Foundation for Women’s Health, Clayton and school of public health, Monash University, Melbourne, Victoria.