美国内分泌学会多囊卵巢综合症诊治指南概述(中文版)

多囊卵巢综合征指南解读多囊卵巢综合征（PCOS）是一种常见的内分泌和代谢异常疾病，其特征包括多囊卵巢、高胰岛素血症和雄激素水平异常。

近年来，随着医疗技术的不断进步以及对该疾病认知的深入，许多国际、国家与地区性的临床指南应运而生。

本文将对多囊卵巢综合征指南进行解读，旨在帮助患者全面了解该疾病的诊断、治疗与管理。

一、诊断标准多囊卵巢综合征的诊断标准因不同指南而异，但主要包括以下几个方面：排除其他导致类似症状的原因，如原发性甲状腺功能减退症、高泌乳素血症等；存在与高胰岛素血症或胰岛素抵抗相关的代谢异常；排除雄激素高水平相关的疾病；多囊卵巢的超声检查发现多囊卵巢样表现。

虽然各指南对于多囊卵巢综合征的诊断标准有所不同，但都强调了综合临床表现、实验室检查和影像学等多方位的综合评估。

二、治疗原则1. 生活方式干预：生活方式干预包括饮食改变、体重控制和增加运动。

饮食改变可以通过限制高GI（高血糖指数）食物、减少饮食热量摄入和优化蛋白质摄入，改善胰岛素抵抗和代谢异常。

体重控制是非常重要的，因为减轻体重可以减少胰岛素抵抗，改善激素水平和生育能力。

增加运动有助于改善胰岛素敏感性和心血管健康。

通过这些生活方式干预措施，可以有效减轻症状、改善代谢异常和生育能力。

2. 药物治疗：药物治疗主要包括胰岛素降低药物、雄激素抑制剂和排卵诱导剂。

胰岛素降低药物如二甲双胍常用于改善胰岛素抵抗和促进排卵。

雄激素抑制剂如口服避孕药可以降低雄激素水平、改善痤疮和面部多毛症等症状。

排卵诱导剂如促性腺激素和辅助生殖技术可用于帮助女性实现妊娠。

3. 症状管理：针对多囊卵巢综合征的症状管理涵盖了多个方面，如面部多毛症的激光脱毛、体重管理、心理支持和排卵周期的监测。

针对不同的症状，可以采取相应的措施进行管理，以提高患者的生活质量。

三、并发症与管理多囊卵巢综合征伴随着一系列潜在的并发症，如糖尿病、高血压、心血管疾病、代谢综合征和不育。

因此，对于多囊卵巢综合征患者的管理应该是全面的。

多囊卵巢综合征的规范化诊治多囊卵巢综合征（PCOS）是女性生殖系统常见的内分泌疾病，其主要特征是激素失调、卵巢多囊变化和排卵障碍。

该综合征的诊治需要综合考虑患者的症状、体征、实验室检查结果以及对患者生活方式的评估，以制定个体化的治疗计划。

本文将介绍PCOS的规范化诊治流程。

一、诊断标准根据国际多囊卵巢综合征协会（Rotterdam Criteria）制定的诊断标准，PCOS的主要诊断依据为以下两项：1）慢性排卵障碍或无排卵表现，即经过超声检查或月经历程可见的两个或更多的卵巢多囊样改变。

2）高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市，异源性雄激素过多引起的高雄市与假性尖叫脑垂体高库激素疾病相似的高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市排除引起高雄市。

二、规范化检查对于确诊的患者应进行全面的检查，包括：1.临床症状和体征评估：包括月经状况、体重、体质指数（BMI）、男性化特征等。

2.生殖激素检测：包括血清促卵泡激素（FSH）、黄体生成素（LH）、睾酮、雌二醇等。

3.代谢指标检测：包括空腹血糖、糖化血红蛋白（HbA1c）、胰岛素、甘油三酯、高密度脂蛋白胆固醇（HDL-C）等。

4.超声检查：主要目的是评估卵巢形态和卵泡数量。

5.其他检查：根据临床需要，可以进行甲状腺功能检查、肾上腺皮质激素检查等。

三、治疗原则对于PCOS患者的治疗应根据患者的症状和需求制定个体化的治疗方案。

常见的治疗原则如下：1.改善生活方式：保持健康的体重、合理的饮食和适量的运动对于改善PCOS的症状非常重要。

患者应减少高糖、高脂肪和高热量的食物摄入，增加蔬菜、水果和全谷物的摄入，适量进行有氧运动。

2.药物治疗：根据患者的需求和症状选择合适的药物治疗。

多囊卵巢综合征诊治指南1000字
多囊卵巢综合征是一种由于荷尔蒙失调引起的常见妇科疾病，常伴
随着月经不规则、生育障碍、肥胖等症状。

以下是关于多囊卵巢综
合征的诊治指南。

1. 诊断
多囊卵巢综合征的诊断基于患者的临床表现、影像学检查结果和生
化指标。

常见的临床表现包括月经不规律、体重增加、男性化特征等。

影像学检查包括超声检查和MRI检查，可以观察卵巢大小、形
态和内部结构等情况。

生化指标包括睾酮、雄二醇、胰岛素等指标。

2. 治疗
目前多囊卵巢综合征的治疗主要包括药物治疗和手术治疗两种方法。

（1）药物治疗
常用的药物包括口服避孕药、胰岛素增敏剂和抗雄激素药物。

口服
避孕药可以有效调节激素水平，改善月经不规则和其他不适症状。

胰岛素增敏剂可以改善胰岛素抵抗和代谢异常。

抗雄激素药物可以
减轻男性化特征和生育障碍等症状。

（2）手术治疗
手术治疗主要是通过腹腔镜手术或电视观察手术进行卵巢囊肿的切除。

在手术后，需要密切监测患者的生殖功能和激素水平，以便针
对性地进行治疗和调节。

3. 生活方式调整
除了药物和手术治疗外，生活方式的改变也是治疗多囊卵巢综合征
的重要方法。

建议患者适量运动，控制饮食，减少精神压力等，以
便改善代谢和激素水平，适度减轻肥胖，提高生育能力。

总之，多囊卵巢综合征是一种常见的妇科疾病，对患者的身心健康
和生育功能都有较大影响。

在治疗中，应根据患者的不同情况提供
个体化的治疗方案，多角度综合治疗，以帮助患者恢复健康。

多囊卵巢综合征诊治指南疾病简介多囊卵巢综合征(polycystic ovary syndrome, PCOS)是生育年龄妇女常见的一种复杂的内分泌及代谢异常所致的疾病，以慢性无排卵(排卵功能紊乱或丧失)和高雄激素血症(妇女体内男性激素产生过剩) 为特征，主要临床表现为月经周期不规律、不孕、多毛和/或痤疮，是最常见的女性内分泌疾病。

疾病分类根据PCOS国际诊断标准(详见诊断部分)诊断的PCOS可以进行亚型分型，以便于个体化治疗选择：1型：经典PCOS，超声卵巢多囊样改变及高雄激素的临床表现和/或高雄激素血症;2型：超声卵巢多囊样改变及稀发排卵或无排卵;3型：NIH标准PCOS，高雄激素的临床表现和/或高雄激素血症及稀发排卵或无排卵;4型：同时具备超声卵巢多囊样改变、高雄激素的临床表现和/或高雄激素血症及稀发排卵或无排卵，此型也被称为经典PCOS。

发病原因目前对于PCOS病因学研究有非遗传理论和遗传理论两种。

PCOS非遗传学理论研究认为孕期子宫内激素环境影响成年后个体的内分泌状态，孕期暴露于高浓度雄激素环境下，如母亲PCOS史、母亲为先天性肾上腺皮质增生症高雄激素控制不良等，青春期后易发生排卵功能障碍。

PCOS遗传学理论此理论的主要根据PCOS呈家族群居现象，家族性排卵功能障碍和卵巢多囊样改变提示该病存在遗传基础。

高雄激素血症和(或)高胰岛素血症可能是PCOS家族成员同样患病的遗传特征，胰岛素促进卵巢雄激素生成作用亦受遗传因素或遗传易感性影响。

稀发排卵、高雄激素血症和卵巢多囊样改变的家族成员中女性发生高胰岛素血症和男性过早脱发的患病率增高。

细胞遗传学研究结果显示PCOS可能为X连锁隐性遗传、常染色体显性遗传或多基因遗传方式。

通过全基因组扫描的发现最大量的与PCOS相关的遗传基因，如甾体激素合成及相关功能的候选基因、雄激素合成相关调节基金、胰岛素合成相关基金、碳水化合物代谢及能量平衡的候选基因、促性腺激素功能及调节的候选基因、脂肪组织相关的基因以及慢性炎症相关基因。

Objective:The aim was to formulate practice guidelines for the diagnosis and treatment of poly-cystic ovary syndrome (PCOS).Participants:An Endocrine Society-appointed Task Force of experts,a methodologist,and a med-ical writer developed the guideline.Evidence:This evidence-based guideline was developed using the Grading of Recommendations,Assessment,Development,and Evaluation (GRADE)system to describe both the strength of rec-ommendations and the quality of evidence.Consensus Process:One group meeting,several conference calls,and e-mail communications enabled mittees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines.Two sys-tematic reviews were conducted to summarize supporting evidence.Conclusions:We suggest using the Rotterdam criteria for diagnosing PCOS (presence of two of the following criteria:androgen excess,ovulatory dysfunction,or polycystic ovaries).Establishing a diagnosis of PCOS is problematic in adolescents and menopausal women.Hyperandrogenism is central to the presentation in adolescents,whereas there is no consistent phenotype in postmeno-pausal women.Evaluation of women with PCOS should exclude alternate androgen-excess disor-ders and risk factors for endometrial cancer,mood disorders,obstructive sleep apnea,diabetes,and cardiovascular disease.Hormonal contraceptives are the first-line management for menstrual ab-normalities and hirsutism/acne in PCOS.Clomiphene is currently the first-line therapy for infertility;metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irreg-ularities,but it has limited or no benefit in treating hirsutism,acne,or infertility.Hormonal con-traceptives and metformin are the treatment options in adolescents with PCOS.The role of weight loss in improving PCOS status per se is uncertain,but lifestyle intervention is beneficial in over-weight/obese patients for other health benefits.Thiazolidinediones have an unfavorable risk-benefit ratio overall,and statins require further study.ISSN Print 0021-972X ISSN Online 1945-7197Printed in U.S.A.Copyright ©2013by The Endocrine SocietyReceived May 24,2013.Accepted September 26,2013.Abbreviations:BMI,body mass index;CI,confidence interval;DM,diabetes mellitus;HC,hormonal contraceptive;HDL,high-density lipoprotein;HgbA1c,hemoglobin A1c;IGT,impaired glucose tolerance;IR,insulin resistance;IVF,in vitro fertilization;LDL,low-density lipoprotein;NAFLD,nonalcoholic fatty liver disease;NASH,nonalcoholic steatohepatitis;OGTT,oral glucose tolerance test;17-OHP,17-hydroxyprogesterone;OHSS,ovarian hy-perstimulation syndrome;OR,odds ratio;OSA,obstructive sleep apnea;PCO,polycystic ovary (or ovaries);PCOS,PCO syndrome;RR,relative risk;T2DM,type 2DM.doi:10.1210/jc.2013-2350J Clin Endocrinol Metab 1J Clin Endocrin Metab. First published ahead of print October 22, 2013 as doi:10.1210/jc.2013-2350Summary of Recommendations1.0Diagnosis of PCOSDiagnosis in adults1.1We suggest that the diagnosis of polycystic ovary syn-drome(PCOS)be made if two of the three following cri-teria are met:androgen excess,ovulatory dysfunction,or polycystic ovaries(PCO)(Tables1and2),whereas dis-orders that mimic the clinical features of PCOS are ex-cluded.These include,in all women:thyroid disease,hy-perprolactinemia,and nonclassic congenital adrenal hyperplasia(primarily21-hydroxylase deficiency by se-rum17-hydroxyprogesterone[17-OHP])(Table3).In se-lect women with amenorrhea and more severe pheno-types,we suggest more extensive evaluation excluding other causes(Table4)(2¦QQQE).Diagnosis in adolescents1.2We suggest that the diagnosis of PCOS in an ado-lescent girl be made based on the presence of clinical and/or biochemical evidence of hyperandrogenism(after exclusion of other pathologies)in the presence of persis-tent oligomenorrhea.Anovulatory symptoms and PCO morphology are not sufficient to make a diagnosis in ad-olescents,as they may be evident in normal stages in re-productive maturation(2¦QQEE).Diagnosis in perimenopause and menopause1.3Although there are currently no diagnostic criteria for PCOS in perimenopausal and menopausal women,we suggest that a presumptive diagnosis of PCOS can be based upon a well-documented long-term history of oligomen-orrhea and hyperandrogenism during the reproductive years.The presence of PCO morphology on ultrasoundTable1.Summary of Proposed Diagnostic Criteria for PCOS in AdultsCategorySpecificAbnormality Recommended Test NIHRotterdam(2of3Met)AndrogenExcess PCOSSociety(Hyper-Androgenismwith1of2RemainingCriteria)Androgenstatus Clinicalhyperandrogenism aClinical hyperandrogenism mayinclude hirsutism(defined as excessiveterminal hair that appears in a malepattern)(1,295),acne,or androgenic alopecia.X X XXBiochemicalhyperandrogenism aBiochemical hyperandrogenism refersto an elevated serum androgen leveland typically includes an elevatedtotal,bioavailable,or free serum Tlevel.Given variability in T levels andthe poor standardization of assays(31),it is difficult todefine an absolute level that isdiagnostic of PCOS or other causes ofhyperandrogenism,and the Task Forcerecommends familiarity with localassays.X X XXMenstrualhistory Oligo-oranovulationAnovulation may manifest as frequentbleedingat intervalsϽ21d orinfrequent bleedingat intervalsϾ35d.Occasionally,bleeding may beanovulatory despite falling at a normalinterval(25–35d).A midlutealprogesterone documentinganovulation mayhelp with thediagnosis if bleeding intervalsappear to suggestregular ovulation.X X XOvarianappearance Ovariansize/morphology onultrasoundThe PCO morphology has beendefined bythe presence of12or morefollicles2–9mm in diameterand/or anincreased ovarian volumeϾ10mL(without a cyst or dominant follicle)ineither ovary(78)X XThe Task Force suggests using the Rotterdam criteria for the diagnosis of PCOS,acknowledging the limitations of each of the three criteria(Table2).All criteria require exclusion of other diagnoses(listed in Table3)that cause the same symptoms and/or signs(6–9).a Clinical or biochemical hyperandrogenism is included as one criterion in all classification systems.If clinical hyperandrogenism is present with the absence of virilization,then serum androgens are not necessary for the diagnosis.Similarly,when a patient has signs of hyperandrogenism and ovulatory dysfunction,an ovarian ultrasound is not necessary.2Legro et al Guidelines on PCOS J Clin Endocrinol Metabwould provide additional supportive evidence,although this is less likely in a menopausal woman(2¦QQEE).2.0Associated morbidity and evaluationCutaneous manifestations2.1We recommend that a physical examination should document cutaneous manifestations of PCOS:terminal hair growth(see hirsutism guidelines,Ref.1),acne,alo-pecia,acanthosis nigricans,and skin tags(1¦QQQE). Infertility2.2Women with PCOS are at increased risk of anovu-lation and infertility;in the absence of anovulation,the risk of infertility is uncertain.We recommend screeningTable2.Diagnostic Strengths and Weaknesses of the Main Features of PCOS as Adapted from the NIH Evidence-Based Methodology Workshop on PCOSDiagnostic Criteria Strength LimitationHyperandrogenism Included as a componentin all majorclassificationsMeasurement is performed only in bloodA major clinical concern for patients Concentrations differ during time of dayAnimal models employingandrogen excessresembling but notfully mimicking humandiseaseConcentrations differ with ageNormative data are not clearly definedAssays are not standardized acrosslaboratoriesClinical hyperandrogenism isdifficult to quantify and may vary byethnic group,eg,low rates of hirsutism inwomen with PCOS from east AsiaTissue sensitivity is not assessedOvulatorydysfunction Included as a componentin all majorclassificationsNormal ovulation is poorly definedA major clinical concernfor patientsNormal ovulation varies over a woman’slifetimeInfertility a common clinical complaint Ovulatory dysfunction is difficult tomeasure objectivelyAnovulatory cycles may have bleedingpatterns that are interpreted as normalPCO morphology Historically associated with syndrome Technique dependentMay be associated with hypersensitivity toovarian stimulation Difficult to obtain standardizedmeasurementLack of normative standards across the menstrual cycle and lifespan(notably in adolescence)May be present in other disorders that mimic PCOSTechnology required to accurately image not universally available Transvaginal imaging possiblyinappropriate incertain circumstances(eg,adolescence)or certain culturesTable3.Other Diagnoses to Exclude in All Women Before Making a Diagnosis of PCOSDisorder Test Abnormal ValuesReference for Further Evaluation and Treatment of AbnormalFindings;First Author,Year(Ref.)Thyroid disease Serum TSH TSHϾthe upper limit of normalsuggests hypothyroidism;TSHϽthe lower limit,usuallyϽ0.1mIU/L,suggestshyperthyroidism Ladenson,2000 (10)Prolactin excess Serum prolactinϾUpper limit of normal for the assay Melmed,2011(11)Nonclassicalcongenital adrenalhyperplasia Early morning(before8AM)serum17-OHP200–400ng/dL depending on the assay(applicable to the early follicular phase ofa normal menstrualcycle as levels rise with ovulation),but acosyntropin stimulation test(250␮g)is needed if levels fall near thelower limit and shouldstimulate17-OHPϾ1000ng/dL.Speiser,2010(12)doi:10.1210/3ovulatory status using menstrual history in all women with PCOS seeking fertility(1¦QQEE).2.3We recommend excluding other causes of infertil-ity,beyond anovulation,in couples where a woman has PCOS(1¦QQEE).Pregnancy complications2.4Because women with PCOS are at increased risk of pregnancy complications(gestational diabetes,preterm delivery,and pre-eclampsia)exacerbated by obesity,we recommend preconceptual assessment of body mass index (BMI),blood pressure,and oral glucose tolerance (1¦QQQE).Fetal origins2.5The evidence for intrauterine effects on develop-ment of PCOS is inconclusive.We suggest no specific in-terventions for prevention of PCOS in offspring of women with PCOS(2¦QEEE).Endometrial cancer2.6Women with PCOS share many of the risk factors associated with the development of endometrial cancer including obesity,hyperinsulinism,diabetes,and abnor-mal uterine bleeding.However,we suggest against routine ultrasound screening for endometrial thickness in women with PCOS(2¦QQQE).Obesity2.7Increased adiposity,particularly abdominal,is as-sociated with hyperandrogenemia and increased meta-bolic risk(see cardiovascular disease prevention guide-lines,Ref.2).Therefore,we recommend screeningTable4.Diagnoses to Consider Excluding in Select Women,Depending on PresentationOther Diagnoses a Suggestive Featuresin the PresentationTests to Assistin the DiagnosisReference forFurther EvaluationandTreatment ofAbnormal Findings;First Author,Year(Ref.)Pregnancy Amenorrhea(as opposed tooligomenorrhea),other signs and symptomsof pregnancy including breast fullness,uterine cramping,etc Serum or urine hCG(positive)Morse,2011(17)HA includingfunctional HA Amenorrhea,clinical history of low bodyweight/BMI,excessive exercise,and a physical exam inwhich signs ofandrogen excess are lacking;multifollicularovaries are sometimes presentSerum LH and FSH(both low to low normal),serum estradiol(low)Wang,2008(18)Primary ovarian insufficiency Amenorrhea combined with symptoms ofestrogen deficiencyincluding hot flashes and urogenitalsymptomsSerum FSH(elevated),serum estradiol(low)Nelson,2009(296)Androgen-secreting tumor Virilization includingchange in voice,malepattern androgenic alopecia,andclitoromegaly rapid onset ofsymptomsSerum T and DHEASlevels(markedly elevated),ultrasoundimaging of ovaries,MRI ofadrenal glands(mass ortumor present)Carmina,2006(16)Cushing’ssyndrome Many of the signs and symptoms ofPCOS can overlap withCushing’s(ie,striae,obesity,dorsocervical fat(ie,buffalo hump,glucose intolerance);however,Cushing’s is more likely to bepresent when a large number of signs andsymptoms,especially those with highdiscriminatoryindex(eg,myopathy,plethora,violaceousstriae,easy bruising)are present,and thispresentationshould lead to screening.24-h urinary collection forurinary free cortisol(elevated),late night salivarycortisol(elevated),overnight dexamethasonesuppression test(failure to suppressmorning serum cortisollevel)Nieman,2008(19)Acromegaly Oligomenorrhea and skin changes(thickening,tags,hirsutism,hyperhidrosis)may overlap with PCOS.However,headaches,peripheral vision loss,enlarged jaw(macrognathia),frontal bossing,macroglossia,increased shoe and glove size,etc,areindications for screening Serum free IGF-1level(elevated),MRI of pituitary(mass ortumor present)Melmed,2009(20)Abbreviations:DHEAS,dehydroepiandrosterone sulfate;HA,hypothalamic amenorrhea;hCG,human chorionic gonadotropin;MRI,magnetic resonance imaging.a Additionally there are very rare causes of hyperandrogenic chronic anovulation that are not included in this table because they are so rare,but they must be considered in patients with an appropriate history.These include other forms of congenital adrenal hyperplasia(eg,11␤-hydroxylase deficiency,3␤-hydroxysteroid dehydrogenase),related congenital disorders of adrenal steroid metabolism or action(eg,apparent/cortisone reductase deficiency,apparent DHEA sulfotransferase deficiency,glucocorticoid resistance),virilizing congenital adrenal hyperplasia(adrenal rests, poor control,fetal programming),syndromes of extreme IR,drugs,portohepatic shunting,and disorders of sex development.4Legro et al Guidelines on PCOS J Clin Endocrinol Metabadolescents and women with PCOS for increased adipos-ity,by BMI calculation and measurement of waist circum-ference(1¦QQQE).Depression2.8We suggest screening women and adolescents with PCOS for depression and anxiety by history and,if iden-tified,providing appropriate referral and/or treatment (2¦QQEE).Sleep-disordered breathing/obstructive sleep apnea (OSA)2.9We suggest screening overweight/obese adolescents and women with PCOS for symptoms suggestive of OSA and,when identified,obtaining a definitive diagnosis us-ing polysomnography.If OSA is diagnosed,patients should be referred for institution of appropriate treatment (2¦QQEE).Nonalcoholic fatty liver disease(NAFLD)and nonal-coholic steatohepatitis(NASH)2.10We suggest awareness of the possibility of NAFLD and NASH but recommend against routine screening (2¦QQEE).Type2diabetes mellitus(T2DM)2.11We recommend the use of an oral glucose toler-ance test(OGTT)(consisting of a fasting and2-hour glu-cose level using a75-g oral glucose load)to screen for impaired glucose tolerance(IGT)and T2DM in adoles-cents and adult women with PCOS because they are at high risk for such abnormalities(1¦QQQE).A hemoglobin A1c(HgbA1c)test may be considered if a patient is unable or unwilling to complete an OGTT(2¦QQEE).Rescreen-ing is suggested every3–5years,or more frequently if clinical factors such as central adiposity,substantial weight gain,and/or symptoms of diabetes develop (2¦QQEE).Cardiovascular risk2.12We recommend that adolescents and women with PCOS be screened for the following cardiovascular disease risk factors(Table5):family history of early cardiovas-cular disease,cigarette smoking,IGT/T2DM,hyperten-sion,dyslipidemia,OSA,and obesity(especially increased abdominal adiposity)(1¦QQEE).3.0TreatmentHormonal contraceptives(HCs):indications and screening3.1We recommend HCs(ie,oral contraceptives,patch, or vaginal ring)as first-line management for the menstrual abnormalities and hirsutism/acne of PCOS(refer to hir-sutism guidelines in Ref.1,recommendation2.1.1,which treat these two problems concurrently)(1¦QQEE).3.2We recommend screening for contraindications to HC use via established criteria(see Table6and Ref.3) (1¦QQQE).For women with PCOS,we do not suggest one HC formulation over another(2¦QQEE).Role of exercise in lifestyle therapy3.3We suggest the use of exercise therapy in the man-agement of overweight and obesity in PCOS(2¦QQEE). Although there are no large randomized trials of exercise in PCOS,exercise therapy,alone or in combination with dietary intervention,improves weight loss and reduces cardiovascular risk factors and diabetes risk in the general population.Role of weight loss in lifestyle therapy3.4We suggest that weight loss strategies begin with calorie-restricted diets(with no evidence that one type of diet is superior)for adolescents and women with PCOS who are overweight or obese(2¦QQEE).Weight loss is likely beneficial for both reproductive and metabolic dys-function in this setting.Weight loss is likely insufficient as a treatment for PCOS in normal-weight women.Use of metformin3.5We suggest against the use of metformin as a first-line treatment of cutaneous manifestations,for prevention of pregnancy complications,or for the treatment of obe-sity(2¦QQEE).3.6We recommend metformin in women with PCOS who have T2DM or IGT who fail lifestyle modification Table5.Cardiovascular Risk Stratification in Women with PCOSAt risk---PCOS women with any of the following risk factors: Obesity(especially increased abdominal adiposity)Cigarette smokingHypertensionDyslipidemia(increased LDL-cholesterol and/or non-HDL-cholesterol)Subclinical vascular diseaseImpaired glucose toleranceFamily history of premature cardiovascular disease(Ͻ55y of age in male relative;Ͻ65yof age in female relative)At high risk---PCOS women with:Metabolic syndromeT2DMOvert vascular or renal disease,cardiovascular diseasesOSAThe Androgen Excess and Polycystic Ovary Syndrome Society relied upon evidence-based studies and concluded that women with PCOS be stratified as being either at risk or at high risk for cardiovascular disease using the criteria shown(167).doi:10.1210/5(1¦QQQE).For women with PCOS with menstrual irreg-ularity who cannot take or do not tolerate HCs,we suggest metformin as second-line therapy(2¦QQQE). Treatment of infertility3.7We recommend clomiphene citrate(or comparable estrogen modulators such as letrozole)as the first-line treatment of anovulatory infertility in women with PCOS (1¦QQQE).3.8We suggest the use of metformin as an adjuvant therapy for infertility to prevent ovarian hyperstimulation syndrome(OHSS)in women with PCOS undergoing in vitro fertilization(IVF)(2¦QQEE).Table6.Considerations for Use of Combined HCs,Including Pill,Patch,and Ring,in Women with PCOS Based on Relevant ConditionsCriteria Further ClassificationConditions1234A condition forwhichthere is norestrictionfor the useof thecontraceptivemethodA conditionfor whichtheadvantages ofusingthe methodgenerallyoutweigh thetheoreticalor provenrisksA conditionfor whichthetheoreticalor provenrisks usuallyoutweigh theadvantagesof using themethodA conditionthatrepresents anunacceptablehealth risk ifthe contra-ceptive methodis usedAge Menarche toϽ40y;Ͼ40y;Smoking AgeՆ35y;AgeՆ35y and smokesϽ15cigarettes/d;AgeՆ35y and smokesՆ15cigarettes/d;Obesity BMIϽ30kg/m2;BMIՆ30kg/m2;Hypertension History ofgestationalhypertension;Adequatelycontrolledhypertension;Elevated bloodpressure levels(properly takenmeasurements):systolic,140–159mm Hg;ordiastolic,90–99mm Hg;Elevated bloodpressure levels(properly takenmeasurements):systolic,Ն160mm Hg;or diastolic,Ն100mm Hg;Dyslipidemia Knownhyperlipidemias;;Depression Depressive disorders;Unexplainedvaginalbleeding(suspicious forseriouscondition)Before evaluation;Diabetes History of gestationaldiabetes;Nonvasculardiabetes,insulin ornon-insulindependent;Vascular diseaseincludingneuropathy,retinopathy,nephropathy;;Diabetes durationϾ20y;;The boxes indicate the recommendation for the condition.The four possible recommendations are a spectrum ranging from condition1,which favors the use of the pill,to condition4,which discourages the use of the pill.[Adapted from:US Medical Eligibility Criteria for Contraceptive Use. MMWR Recomm Rep.2010;59:1–86(3),with permission.©Centers for Disease Control and Prevention.]6Legro et al Guidelines on PCOS J Clin Endocrinol MetabUse of other drugs3.9We recommend against the use of insulin sensitiz-ers,such as inositols(due to lack of benefit)or thiazoli-dinediones(given safety concerns),for the treatment of PCOS(1¦QQQE).3.10We suggest against the use of statins for treatment of hyperandrogenism and anovulation in PCOS until ad-ditional studies demonstrate a favorable risk-benefit ratio (2¦QQEE).However,we suggest statins in women with PCOS who meet current indications for statin therapy (2¦QQEE).Treatment of adolescents3.11We suggest HCs as the first-line treatment in ad-olescents with suspected PCOS(if the therapeutic goal is to treat acne,hirsutism,or anovulatory symptoms,or to prevent pregnancy)(2¦QQEE).We suggest that lifestyle therapy(calorie-restricted diet and exercise)with the ob-jective of weight loss should also be first-line treatment in the presence of overweight/obesity(2¦QQEE).We suggest metformin as a possible treatment if the goal is to treat IGT/metabolic syndrome(2¦QQEE).The optimal dura-tion of HC or metformin use has not yet been determined.3.12For premenarchal girls with clinical and biochem-ical evidence of hyperandrogenism in the presence of ad-vanced pubertal development(ie,ՆTanner stage IV breast development),we suggest starting HCs(2¦QQEE). Method of Development of Evidence-Based Clinical Practice GuidelinesThe Clinical Guidelines Subcommittee of The Endocrine Society deemed the diagnosis and treatment of PCOS a priority area in need of practice guidelines and appointed a Task Force to formulate evidence-based recommenda-tions.The Task Force followed the approach recom-mended by the Grading of Recommendations,Assess-ment,Development,and Evaluation(GRADE)group,an international group with expertise in development and implementation of evidence-based guidelines(4).A de-tailed description of the grading scheme has been pub-lished elsewhere(5).The Task Force used the best avail-able research evidence to develop the recommendations. The Task Force also used consistent language and graph-ical descriptions of both the strength of a recommendation and the quality of evidence.In terms of the strength of the recommendation,strong recommendations use the phrase “we recommend”and the number1,and weak recom-mendations use the phrase“we suggest”and the number 2.Cross-filled circles indicate the quality of the evidence, such that QEEE denotes very low quality evidence;QQEE,low quality;QQQE,moderate quality;and QQQQ,high quality.The Task Force has confidence that persons who receive care according to the strong recom-mendations will derive,on average,more good than harm. Weak recommendations require more careful consider-ation of the person’s circumstances,values,and prefer-ences to determine the best course of action.Linked to each recommendation is a description of the evidence and the values that panelists considered in making the recom-mendation;in some instances,there are remarks,a section in which panelists offer technical suggestions for testing conditions,dosing,and monitoring.These technical com-ments reflect the best available evidence applied to a typ-ical person being treated.Often this evidence comes from the unsystematic observations of the panelists and their values and preferences;therefore,these remarks are considered.The Endocrine Society maintains a rigorous conflict of interest review process for the development of clinical practice guidelines.All Task Force members must declare any potential conflicts of interest,which are reviewed be-fore they are approved to serve on the Task Force and periodically during the development of the guideline.The conflict of interest forms are vetted by the Clinical Guide-lines Subcommittee(CGS)before the members are ap-proved by the Society’s Council to participate on the guideline Task Force.Participants in the guideline devel-opment must include a majority of individuals without conflict of interest in the matter under study.Participants with conflicts of interest may participate in the develop-ment of the guideline,but they must have disclosed all conflicts.The CGS and the Task Force have reviewed all disclosures for this guideline and resolved or managed all identified conflicts of interest.Conflicts of interest are defined by remuneration in any amount from the commercial interest(s)in the form of grants;research support;consulting fees;salary;owner-ship interest(eg,stocks,stock options,or ownership in-terest excluding diversified mutual funds);honoraria or other payments for participation in speakers’bureaus,ad-visory boards,or boards of directors;or other financial pleted forms are available through The En-docrine Society office.Funding for this guideline was derived solely from The Endocrine Society,and thus the Task Force received no funding or remuneration from commercial or other entities.1.0Diagnosis of PCOSDiagnosis in adults1.1We suggest that the diagnosis of PCOS be made if two of the three following criteria are met:androgen ex-doi:10.1210/7cess,ovulatory dysfunction,or PCO(Tables1and2), whereas disorders that mimic the clinical features of PCOS are excluded.These include,in all women:thyroid disease, hyperprolactinemia,and nonclassic congenital adrenal hyperplasia(primarily21-hydroxylase deficiency by se-rum17-OHP)(Table3).In select women with amenor-rhea and more severe phenotypes,we suggest more exten-sive evaluation excluding other causes(Table4) (2¦QQQE).1.1EvidencePCOS is a common disorder with systemic metabolic manifestations.Its etiology is complex,heterogeneous, and poorly understood.There are three definitions for PCOS currently in use that variably rely on androgen ex-cess,chronic anovulation,and PCO to make the diagnosis (Table1).However,all criteria are consistent in that PCOS is considered a diagnosis of exclusion.All three sets of diagnostic criteria include hyperandrogenism,either clin-ical or biochemical,and anovulation(6–9).The Rotter-dam criteria were the first to incorporate ovarian mor-phology on ultrasound as part of the diagnostic criteria(8, 9).The panel from a recent National Institutes of Health (NIH)-sponsored Evidence-Based Methodology work-shop on PCOS endorsed the Rotterdam criteria,although they identified the strengths and weaknesses of each of the three cardinal features(Table2).These criteria allow the diagnosis to be made clinically(based upon a history of hyperandrogenic chronic anovulation)as well as bio-chemically with androgen assays or with ultrasound ex-amination of the ovaries.We do not endorse the need for universal screening with androgen assays or ultrasound if patients already meet two of the three criteria clinically.It is recommended that the features leading to the diagnosis are documented.We recommend using the current defi-nition of the Rotterdam criteria to document PCO mor-phology(at least one ovary with12follicles of2–9mm or a volumeϾ10mL in the absence of a dominant follicleϾ10mm),in the absence of age-based criteria.Disorders that mimic PCOS are comparatively easy to exclude;therefore,all women should be screened with a TSH,prolactin,and17-OHP level(Table3)(10–12).Hy-perprolactinemia can present with amenorrhea or hirsut-ism(13,14).Thyroid disease may present with irregular menstrual cycles.In women with hyperandrogenism,non-classic congenital adrenal hyperplasia should be excluded because it can be found in1.5–6.8%of patients presenting with androgen excess(15,16).In select women who pres-ent with amenorrhea,virilization,or physical findings not associated with PCOS,such as proximal muscle weakness (Cushing’s syndrome)or frontal bossing(acromegaly),other diagnoses should be considered and excluded(Table 4)(16–20Morse278,Wange279,Carmina13,Nieman 281,Melamed282).1.1Values and preferencesIn the absence of evidence-based diagnostic criteria,we have relied on the recommendations of the NIH Panel as noted above.The presence of specific phenotypic features may result in different risk and comorbidity profiles.For example,hyperandrogenism may be more highly associ-ated with metabolic abnormalities,whereas irregular menses and PCO morphology may be more highly asso-ciated with infertility.When interpreting published re-search,clinicians should note that criteria different from their own may be used when performing research.The committee notes that the diagnosis of PCOS is problematic in women who are perimenarchal or perimenopausal be-cause amenorrhea and oligomenorrhea are natural stages in reproductive maturation and senescence,as are changes in circulating androgens and ovarian morphology.There-fore,we discuss the diagnosis of PCOS separately in these groups.Finally,because there is evidence of a genetic com-ponent to PCOS and familial clustering of reproductive and metabolic abnormalities in male and female relatives, a careful family history should be taken,and further screening of first-degree relatives is a consideration. Diagnosis in adolescents1.2We suggest that the diagnosis of PCOS in an ado-lescent girl be made based on the presence of clinical and/or biochemical evidence of hyperandrogenism(after exclusion of other pathologies)in the presence of persis-tent oligomenorrhea.Anovulatory symptoms and PCO morphology are not sufficient to make a diagnosis in ad-olescents because they may be evident in normal stages in reproductive maturation(2¦QQEE).1.2EvidenceAll PCOS diagnostic criteria were derived for adults (Table1),not adolescents.Furthermore,normal adoles-cent physiology may mimic symptoms of PCOS.Oligom-enorrhea is common after menarche during normal pu-berty and is therefore not specific to adolescents with PCOS.Anovulatory cycles comprise85%of menstrual cycles in the first year after menarche,59%in the third year,and25%by the sixth year.Anovulatory cycles are associated with higher serum androgen and LH levels(21). Approximately two-thirds of adolescents with PCOS will have menstrual symptoms,and for one-third it will be the presenting symptom,with the spectrum from primary amenorrhea to frequent dysfunctional bleeding(22). Therefore,it is appropriate to evaluate persistent oligom-8Legro et al Guidelines on PCOS J Clin Endocrinol Metab。

多囊性卵巢综合征的诊治共识背景：多囊性卵巢综合征（PCOS）是一种常见的内分泌系统疾病，主要特征包括多囊卵巢、排卵障碍和高雄激素血症。

该综合征常伴有不孕、代谢紊乱、心血管疾病等并发症，对患者的生活质量和生育能力造成了影响。

诊断方法：PCOS的诊断主要依靠临床症状、体征和实验室检查。

根据国际多囊卵巢综合征协会（Rotterdam criteria）的建议，诊断PCOS 需要满足以下两个标准之一：1）慢性排卵障碍、高雄激素血症和多囊卵巢的可见影像学表现；2）排除了其他疾病原因后，同时存在慢性排卵障碍和高雄激素血症。

治疗策略：治疗PCOS的主要目标是改善患者的排卵功能、减少症状并防止并发症的发生。

治疗策略包括以下方面：1）改变生活方式：包括饮食调整、体重管理和适量的体力活动，有助于改善代谢紊乱和减轻症状。

2）药物治疗：根据患者的具体情况选择药物治疗，常用的药物包括口服避孕药、抗雄激素药物和胰岛素增敏剂等。

药物治疗应根据个体差异进行个体化调整。

3）辅助生殖技术：对于不孕的患者，辅助生殖技术如体外受精（IVF）可以提高妊娠率。

选择合适的辅助生殖技术需要考虑患者的年龄、排卵功能和伴随疾病等因素。

随访与管理：PCOS是一种慢性疾病，需要长期的随访与管理。

定期复查血液激素水平、卵巢超声检查和其他相关检查有助于评估疾病进展和调整治疗方案。

此外，患者的生活方式和心理健康也需要关注和支持。

结论：PCOS的诊治共识建议通过综合运用生活方式改变、药物治疗和辅助生殖技术等综合策略来管理该疾病。

个体化的治疗方案和定期的随访对于提高患者的生活质量和预防并发症的发生至关重要。

多囊卵巢综合征的诊断和治疗指南多囊卵巢综合征（PCOS）是一种常见的妇科内分泌疾病，影响着大量中国女性。

该病的临床表现多样，不仅会严重影响患者的生殖功能，还会增加患上雌激素依赖性肿瘤如子宫内膜癌的风险。

同时，相关的代谢失调也会增加糖代谢异常、心血管疾病等并发症的风险。

然而，PCOS的病因尚不明确，诊断标准不统一，治疗方案也缺乏合理的防治措施。

因此，XXX内分泌学组于2006年11月18日在重庆召开了妇科内分泌学专家扩大会议，制定了中国的PCOS诊断、治疗专家共识。

据统计，PCOS占生育年龄妇女的5%至10%。

其还是无排卵性不孕症患者的30%至60%。

以ESHRE/ASRM建议诊断标准，济南市、烟台市育龄妇女PCOS患病率分别为6.46%和7.2%。

济南市汉族PCOS患者主要分布在35岁以下群体。

尽管如此，我国尚缺少全国性、大样本、多中心研究。

多囊卵巢综合征的确切病因尚不清楚，但研究表明它可能是由某些遗传基因与环境因素相互作用引起的。

其中，PCOS有家族聚集现象，被推测为一种多基因病。

目前的候选基因研究涉及胰岛素作用相关基因、高雄激素相关基因和慢性炎症因子等。

此外，环境因素包括宫内高雄激素、抗癫癎药物、地域、营养和生活方式等，可能是PCOS的危险因素、易患因素、高危因素。

但它们不能算是病因，应进行流调后完善环境与PCOS关系的认识。

PCOS的诊断标准一直是本领域专家争论的问题。

1935年，XXX和XXX首次描述了闭经、多毛和双侧卵巢多囊性增大（polycysticovary，PCO）的无排卵相关综合征（S-L征）。

1990年NIH制定了PCOS诊断标准，包括月经异常和无排卵、临床或生化显示高雄激素血症、排除其他引起高雄激素血症的疾病，未将卵巢的多囊改变（polycystic ovary，PCO）作为诊断的主要症状。

2003年，欧洲人类生殖和胚胎与XXX的（ESHRE/ASRM）鹿特丹专家会议推荐的标准，是目前全球PCOS的诊断标准。