PCOS 2023 international guidelines have just been released. In this blog, we discuss the new evidence-based updates and considerations.


PCOS: What is it and how is it diagnosed?

Polycystic ovarian syndrome is one of the most common endocrine disorders and can be a risk factor for infertility and pregnancy loss. It can also be a risk factor for cardiovascular disease. Studies show that those with PCOS are twice as likely at risk of future cardiac event, heart attack, or stroke. So whether or not you’re trying to conceive, every woman diagnosed or being assessed for PCOS should know their risk.


The previous diagnosis is based on the Rotterdam Criteria, requiring the patient to have 2/3 of the following:

  1. Irregular or absent cycles
  2. Symptoms or blood levels indicated excess androgens (symptoms may include acne, hair loss, hirsutism or facial hair growth and more).
  3. Polycystic ovaries (i.e. multiple cysts on ovaries observed via ultrasound)


Recently this diagnostic criteria has been updated. It now suggests:

  1. Irregular or absent cycles
  2. Symptoms or blood levels indicated excess androgens
  3. Polycystic ovaries (i.e. multiple cysts on ovaries observed via ultrasound) OR high levels of AMH


This is a great adjustment because not everyone with PCOS has cystic ovaries, or cystic ovaries can go away as the patient ages even though they still have PCOS. This means we are potentially misdiagnosing people. An ultrasound is also not always accessible to people.


What is AMH?


AMH, or Antimullerian hormone is secreted by they follicle and is commonly run to understand the quantity of eggs in the ovary. Those with diminished ovarian reserve typically have lower AMH levels. In PCOS, there are more follicles and each follicle makes more AMH, thus those with PCOS often have higher AMH levels. 


2023 Guidelines now suggest this to be an effective alternative to ultrasound in the diagnosis of PCOS. 


It’s important to note that AMH changes with age so your levels should be assessed by a qualified healthcare provider.


Other key updates to the 2023 guidelines:

  • Lifestyle medicine and nutrition support should be offered to ALL PCOS patients
  • No specific diet or exercise has been shown to be effective- individualized care key here
  • High-risk pregnancy is more common in PCOS
  • Screening and support for eating disorders and mental health conditions should be considered


Key considerations when treating PCOS

PCOS is a complex, metabolic syndrome. In my opinion, the number one cause of treatment failure is a lack of proper assessment. There are a number of associated lab findings and clinical signs/symptoms that help us figure out what is going on in YOUR specific PCOS case because no two cases are the same. A “general” treatment plan for PCOS does not exist, and it’s difficult to get a resolution when that model is used.


We see a number of patterns in a PCOS picture:


  • Differences in brain hormones and their pattern of release
  • Differences in ovarian production of testosterone, estrogen, and progesterone
  • Differences in ovarian blood sugar balance and signaling- aka insulin resistance
  • Differences in how cortisol (our stress hormone) is regulated
  • Differences in inflammatory markers
  • Differences in gut microbiome balance
  • Differences in thyroid balance
  • Differences in nutritional markers, such a Vitamin D or B vitamins
  • Differences in other metabolic parameters such as cholesterol


If you’re looking for a tailored assessment and treatment plan for PCOS - schedule a free discovery call to review how the plan may look for you. You can do that here.



In Health,

Dr. Ashley Damm, ND



References: 

  • Helena J. Teede, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertility and Sterility, 2023.
  • McCartney CR, Eagleson CA, Marshall JC. Regulation of gonadotropin secretion: implications for polycystic ovary syndrome. Semin Reprod Med. 2002 Nov;20(4):317-26. doi: 10.1055/s-2002-36706. PMID: 12536355.
  • DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril. 2005 May;83(5):1454-60. doi: 10.1016/j.fertnstert.2004.11.070. PMID: 15866584.
  • Tasoula Tsilchorozidou and others, Altered Cortisol Metabolism in Polycystic Ovary Syndrome: Insulin Enhances 5α-Reduction But Not the Elevated Adrenal Steroid Production Rates, The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 12, 1 December 2003, Pages 5907–5913, https://doi.org/10.1210/jc.2003-030240
  • Yurtdaş G, Akdevelioğlu Y. A New Approach to Polycystic Ovary Syndrome: The Gut Microbiota. J Am Coll Nutr. 2020 May-Jun;39(4):371-382. doi: 10.1080/07315724.2019.1657515. Epub 2019 Sep 12. PMID: 31513473.
  • Lin MW, Wu MH. The role of vitamin D in polycystic ovary syndrome. Indian J Med Res. 2015 Sep;142(3):238-40. doi: 10.4103/0971-5916.166527. PMID: 26458338; PMCID: PMC4669857.
  • Echiburú B, Crisosto N, Maliqueo M, Pérez-Bravo F, de Guevara AL, Hernández P, Cavada G, Rivas C, Clavel A, Sir-Petermann T. Metabolic profile in women with polycystic ovary syndrome across adult life. Metabolism. 2016 May;65(5):776-782. doi: 10.1016/j.metabol.2016.01.006. Epub 2016 Jan 16. PMID: 27085784.