Understanding the latest PCOS Guidelines

The International Evidence-based Guidelines for the assessment and management of Polycystic Ovary Syndrome (PCOS) 2023 have been published. They were designed to help health professionals like myself, but also provide useful information for anyone living with PCOS.

Over 1000 healthcare professionals, researchers and academics experts, multidisciplinary clinicians and patients/consumers internationally were consulted to develop these guidelines which have been periodically updated since 2011. These guidelines were over 200 pages long so I will provide a small snapshot of some of the key recommendations.

Key changes with diagnosis of PCOS

PCOS is diagnosed using the revised Rotterdam criteria which requires the presence of 2 or more of the following; clinical or biochemical hyperandrogenism, ovulatory dysfunction and polycystic ovaries or now the recently added elevated Anti-Mullerian Hormone levels (AMH). The inclusion of a AMH test, as an alternative to pelvic ultrasound, is much less invasive and cheaper for clients, therefore allowing a prompter diagnosis.

Key recommendations for the management of PCOS

· Lifestyle interventions which focus on exercise and dietary changes should be offered to all people with PCOS and be a primary focus

· A lifelong reproductive health plan is recommended, including a focus on risk factors pre-conception, a healthy lifestyle and prevention of weight gain and optimisation of fertility

· A focus on prevention of excessive weight gain with aging

· Women with PCOS should be considered at an increased risk of cardiovascular disease and therefore blood lipids and blood pressure should be routinely checked

· Women with PCOS are also at increased risk of impaired fasting glucose, impaired glucose tolerance and type 2 diabetes, regardless of age. Therefore these should be routinely checked.

· No one dietary pattern surpasses another, emphasising the need for tailored and individual dietary and lifestyle plans from qualified Dietitians with expertise in PCOS

· Weight bias and stigma should be minimised and healthcare professionals and clients should work collaboratively to make health decisions, with a consideration for cultural and ethnic factors. Practitioners should also seek permission to weigh women with an explanation of weight-related risks.

· Increased acknowledgment of the psychological features of PCOS including depression, anxiety, eating disorders and impacts on body image and quality of life

· PCOS should be considered a high-risk condition in pregnancy due to the increased risk of various complications, including gestational weight gain, miscarriage, gestational diabetes, preeclampsia, low birth weight babies and preterm delivery along with caesarean section. Early lifestyle intervention should be offered to pregnant women with PCOS, given these risks of pregnancy complications.

PCOS is a lifelong condition at which diet and lifestyle changes play a big role and are really at the forefront of long-term management! Seeking the help of an Accredited Practising Dietitian who specialised in PCOS early is so crucial. So let me help you navigate this complex condition and develop a personalised diet plan which will help you to take charge of your nutrition and reach your health goals!