PCOS guidelines

I believe that this is one of those diagnoses where you have to treat the patient according to patient-specific issues. The guidelines are meant to steer you straight, but not everything in them is appropriate for every patient.

THank you! i found a number of national guidelines and they all have pretty much the same recommendations. Just curious, do you see PCOS patients? what is your recommendation for follow-up and monitoring?

PCOS is not something that I used to see often when I did primary care. However, as a general rule, I always treat any patient according to objective and subjective data, and not just arbitrarily according to any guideline. Some things are standard, i.e. lifestyle modification to promote weight loss (most of them are usually overweight), metformin, antiestrogens (if the patient wants to get pregnant) and dexa, etc. Maybe the patient doesn't want to get pregnant, has a beard, or whatever, and needs antiandrogens and an OCP instead. But you have to consider things that may not be appropriate---depending on the patient. For instance, even though the guidelines suggest OCPs, I wouldn't prescribe them if the patient is over a certain age, or a chain smoker, or has other high-risk history. And some people may be refractory and need step-up treatment. If the case is high risk or very complicated I refer to endocrinology and fertility specialists.

Follow-up depends on what you are doing. I ask them to come back every 3 months for labs and reassessment for at least a year. If they stabilize then I stretch it out to twice a year. How frequently you see them also depends on which medications you put them on.