PCOS pharmacotherapeutic approach for junior pharmacists

Guide for pharmacists on PCOS: Assessment, diagnosis, and evidence-based pharmacotherapy. Doses, durations, and expert insights provided...

Introduction

Polycystic Ovarian Syndrome (PCOS) is a multifaceted endocrine disorder prevalent among women of reproductive age. This article aims to provide pharmacists in clinical practice with a nuanced understanding of PCOS assessment, suspicion, and an evidence-based pharmacotherapeutic approach.

Assessment

Diagnostic criteria

The diagnostic criteria for polycystic ovary syndrome (PCOS) are based on the Rotterdam Criteria, which require at least two out of three symptoms: hyperandrogenism, ovulatory dysfunction, and polycystic ovaries detected through ultrasound.

Clinical evaluation involves assessing menstrual irregularities, hirsutism, acne, androgenic alopecia, and obesity, as these are common manifestations of PCOS.
Laboratory investigations are crucial and typically include measuring serum androgen levels such as testosterone and DHEAS, along with fasting glucose, insulin levels, and a lipid profile to aid in diagnosis and management of the condition.

Suspecting PCOS

Clinical suspicion of polycystic ovary syndrome (PCOS) arises with persistent menstrual irregularities or clinical signs of hyperandrogenism. To ensure accurate diagnosis, other conditions such as thyroid dysfunction, hyperprolactinemia, and non-classical adrenal hyperplasia must be ruled out. Imaging, typically a pelvic ultrasound, is employed to identify polycystic ovaries, contributing to the comprehensive assessment for confirming PCOS.

Pharmacotherapeutic approach

Medications

See our notes, "PCOS treatment based on symptoms" and "Medications for PolyCystic Ovary Syndrome (PCOS)".

Table (1)

Meds for polycystic ovary syndrome.

Comments on medications

Oral contraceptives: Consider in non-fertility seeking patients for cycle regulation and management of hyperandrogenism.
Metformin: Indicated for insulin resistance, consider in obese patients or those with impaired glucose tolerance.
Clomiphene citrate and Letrozole: Reserved for women desiring pregnancy, monitor closely for ovulation and adjust doses if necessary.

References

Conway G, Dewailly D, Diamanti-Kandarakis E, et al. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol. 2014;171(4):P1-P29.
Tang T, Lord JM, et al. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2012;(5):CD003053.
Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018;110(3):364-379.