Polyendocrine Metabolic Ovarian Syndrome (PMOS) previously known as Polycystic Ovarian Syndrome (PCOS)
NHS Tayside RefGuide
Who to refer
Consider routine referral if there is diagnostic uncertainty after initial assessment (unable to confirm 2 of 3 features).
Urgently
Presentation suggestive of androgen secreting tumour or non-classical Congenital Adrenal Hyperplasia (NC-CAH) or also known as late onset CAH.
Rapid virilisation (rapid onset: deepening voice, clitoromegaly, severe hirsutism, reduced breast size, increased muscle bulk)
Very high serum testosterone (> ~5 nmol/L or >2× upper limit of normal)
Suspected androgen-secreting ovarian/adrenal tumour on examination or imaging.
Who not to refer
Fertility difficulty –refer to fertility services
Menstrual problems –refer to gynaecology
Severe acne and/or problematic hirsutism –refer to dermatology
Obesity – refer to weight management services
How to refer
Referral to Endocrinology is via SCI-gateway
Specialty Description
Polycystic Ovarian Syndrome
Polycystic ovarian syndrome (PCOS) is a common hormonal disorder in which there are higher than normal androgen levels which can lead to irregular menstrual periods, abnormal ovulation, infertility, excess facial or body hair and/or acne in women. It is often characterised by insulin resistance.
Diagnose PCOS in adults using the revised evidence-based Rotterdam approach (need 2 of 3):
Clinical/biochemical hyperandrogenism (see links below)
Ovulatory dysfunction
Polycystic ovarian morphology on ultrasound or elevated Anti-Mullerian Hormone) AMH
Primary Care Investigations
Investigations GPs should perform before referral (tailor to presentation):
Full history & exam: menstrual history, fertility desires, hair growth, acne, weight/BMI, BP, signs of virilisation.
Metabolic screening: fasting glucose or HbA1c; consider fasting lipids; BMI and BP
Hormones: total testosterone, FSH, LH, SHBG, TSH, prolactin.
Other tests: consider liver function tests; pregnancy test and fertility counselling if relevant.
Ultrasound: in adults, pelvic ultrasound (transvaginal or transabdominal)— but if clinical hyperandrogenism + irregular cycles are present, ultrasound is not required to make the diagnosis
Useful resources
https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/diagnosis/investigations/
Polycystic ovary syndrome - Symptoms, diagnosis and treatment | BMJ Best Practice