What Changed In PCOS Care This Year — And What To Ask Your Doctor

Polycystic ovary syndrome affects somewhere between eight and thirteen percent of women of reproductive age, and up to seventy percent of cases are thought to be undiagnosed. It is also a condition where the guidance has moved faster than the average appointment has.

Here is what has changed and what it means for the conversation you have next.

The diagnosis has become less dependent on ultrasound

PCOS is still diagnosed on the Rotterdam criteria — two of three from irregular ovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology. What has changed is that a raised anti-Müllerian hormone level can now stand in for the ultrasound in adults.

That matters practically: it removes a transvaginal scan from the pathway for women who would find one distressing, and it shortens a diagnostic process that often runs to years.

Metabolic screening for everyone

The insulin resistance associated with PCOS is not confined to women with a high BMI, and the assumption that it is has meant lean women with PCOS were routinely under-screened.

“The recommendation now is a glucose tolerance test or HbA1c and a lipid profile at diagnosis and periodically after, regardless of body weight,” says Dr Ngata. “That is a meaningful change in who gets tested.”

Mental health is in the guideline

Rates of anxiety, depression and disordered eating are substantially elevated in PCOS, and screening for them is now explicitly part of routine care rather than an optional extra.

“For a lot of patients this is the first time anyone has connected the two,” says Dr Boateng. “It reframes the whole condition.”

What the evidence supports for management

Combined hormonal contraception remains first line for cycle regulation and hyperandrogenic symptoms. Metformin has a role, particularly where metabolic features dominate. Inositol has some supportive evidence and an unusually good safety profile, though it is not equivalent to a licensed medicine.

Exercise — resistance training in particular — improves insulin sensitivity independently of any change in weight, which is worth stating clearly to anyone who has only ever been advised to lose some.

Five questions worth asking

Which of the three criteria do I actually meet? Have I been screened metabolically this year? What is my cardiovascular risk given this diagnosis? If I want to conceive in the next few years, what should I be doing now? And: what would you recommend if my weight were not part of this conversation?