Monitoring
Long-Term Follow-Up
Polycystic ovarian syndrome is associated with an increased risk of multiple comorbidities resulting from unopposed estrogen due to anovulation. Monitor for onset of the following associated diseases:
Obesity
Measure waist circumference and calculate body mass index yearly. Measure a fasting lipid profile at diagnosis regardless of the patient's age. Subsequent measurement should be guided by the test result and global CVD risk.
Dyslipidemia
Screen blood lipid levels every 6 months or more frequently if with interval weight gain.
Type 2 DM, Impaired Glucose
Tolerance, Gestational Diabetes
Baseline assessment of glycemic status with an oral glucose tolerance test (OGTT), fasting plasma glucose, or HbA1c should be performed in all women with polycystic ovarian syndrome and thereafter every 1-3 years based on the presence of other diabetes risk factors. A 75 g OGTT is the most accurate test to determine glycemic status in polycystic ovarian syndrome regardless of BMI. OGTT is recommended in high-risk women with polycystic ovarian syndrome with BMI >25 kg/m2 (Asians >23 kg/m2), a history of abnormal glucose tolerance, a family history of type 2 DM, hypertension, or high-risk ethnicity. HbA1c may be done if OGTT cannot be performed. Offer OGTT to all women with polycystic ovarian syndrome when planning pregnancy or seeking fertility treatment due to the increased risk of hyperglycemia and comorbidities in pregnancy. If not performed prior to conception, offer OGTT at <20 weeks gestation and at 24-28 weeks gestation for all women with polycystic ovarian syndrome.
Cardiovascular Disease (CVD)
All women with polycystic ovarian syndrome should be evaluated for individual CV risk factors and global CVD risk. Monitor blood pressure at every visit or more frequently depending on the patient's global CVD risk. Measure weight, height, and waist circumference, and calculate BMI. Monitor weight at every visit or at 6-12 monthly with subsequent visits as agreed upon by the physician and the patient. Follow the World Health Organization (WHO) guidelines for BMI categories and waist circumference, taking note of ethnic and adolescent ranges. Consider Asian and high-risk ethnic groups, including waist circumference monitoring.
Endometrial Cancer
Transvaginal ultrasound and/or endometrial biopsy are recommended in patients with persistent thickened endometrium and/or risk factors (eg excess weight, prolonged amenorrhea, abnormal vaginal bleeding). Routine screening with ultrasound for endometrial thickness in polycystic ovarian syndrome is not recommended.
Obstructive Sleep Apnea (OSA)
Consider screening for obstructive sleep apnea in patients with polycystic ovarian syndrome to identify and relieve related symptoms and not for improving cardiometabolic risk, as evidence is inadequate for the metabolic benefits of OSA treatment in polycystic ovarian syndrome. Screen with symptom assessment, preferably with the Berlin questionnaire, and if positive, consider a specialist referral for further evaluation.