Polycystic Ovarian Syndrome (PCOS)

Discharge Criteria:

1. If oligomenorrhea is present, then either:

• Medical therapy has been initiated for endometrial protection (e.g. OCP, cyclical progestin, IUD, Nexplanon +/- metformin), or
• Natural cycles are occurring less than 3 months apart and there is no DUB (dysfunctional uterine bleeding)

2. If symptoms of hyperandrogenism are present, then either:

• Medical therapy is not desired/tolerated, or
• Medical therapy is started, and patient is on a stable dose (for ongoing prescription from PCP)

3. Initial screening for cardiometabolic risk is completed:

• Including BP, BMI, HbA1c/75g OGTT, lipid profile, sleep study (if symptomatic)

4. Patient has no current pregnancy plans (within the next year) or is already followed by a fertility specialist

Resources:

• Letter to primary care provider
• Letter to patient

Topic Expert Review: Olexandra Koshkina, Alyse Goldberg, Alvita Chan (Endocrinologists)

Plain language review: Katrina Grieve, St Michael's Hospital

References:

1. Dason ES, Koshkina O, Chan C, et al Diagnosis and management of polycystic ovarian syndrome. CMAJ 2024;196: E85–94

2. l Wattar BH, Fisher M, Bevington L, Talaulikar V, Davies M, Conway G, Yasmin E. Clinical Practice Guidelines on the Diagnosis and Management of Polycystic Ovary Syndrome: A Systematic Review and Quality Assessment Study. J Clin Endocrinol Metab. 2021 Jul 13;106(8):2436-2446. doi: 10.1210/clinem/dgab232. PMID: 33839790; PMCID: PMC8830055. 3. https://mchri.org.au/guidelines-resources/health-professionals/pcos-practice-tools/ 4. https://mchri.org.au/guidelines-resources/community/pcos-resources