Clinical practice guidelines (CPGs) are key instruments to implement the practice of evidence-based medicine. We aimed to evaluate the methodological quality and variations in CPGs recommendations on the diagnosis and management of polycystic ovary syndrome (PCOS). We searched MEDLINE, EMBASE, and CENTRAL until December 2020 for all evidence-based CPGs and consensus statements on PCOS. We extracted data in duplicate to map clinical recommendations across pre-specified disease domains and assessed CPGs methodological quality of using the AGREE II tool. We included thirteen PCOS CPGs were published between 2007-2018. CPGs recommendations were mostly focused on screening for and managing metabolic disease (12/13, 92%), followed by cardiovascular risk assessment (10/13, 77%). Mental health (8/13, 62%) and diagnosis in adolescents (7/13, 54%) were the least reported domains. Most CPGs had a high quality for scope and purpose description (12/13, 92%) while stakeholder’s involvement and applicability of recommendations to clinical practice were appropriate in only two CPGs (2/13, 15%). We identified inconsistency in recommendations on PCOS diagnosis in adolescents, optimal lifestyle interventions, hirsutism and acne treatments, interventions to reduce the risk of ovarian hyperstimulation syndrome, the frequency and screening criteria for metabolic and cardiovascular disease, and on optimal screening tools for mental health illness in women with PCOS. Current CPGs on the diagnosis and management of PCOS vary in their scope and methodological quality which may hinder evidence translation into clinical practice. We identified disease domains with existing evidence gap to guide future research and guideline updates.

We searched MEDLINE, EMBASE, and Cochrane CENTRAL databases within the NICE Healthcare Database Advanced Search platform (hdas.nice.org.uk) using the following search terms to identify eligible CPGs on PCOS from inception until December 2020: Clinical, CPGs, consensus statement, position statement, recommendation?, polycystic ovary, polycystic ovary syndrome, hyperandrogen, anovulation, menorrhea, wom?n, female, pregnan*. Complementary searches were conducted in Google Scholar, Tripdatabase and Scopus. We searched the websites of established regulatory bodies on the topic of care for women with PCOS to identify relevant CPGs. We did not apply any search filters or language limitations. Two independent reviewers (LB and MF) extracted data in duplicate into an electronic Excel sheet which was piloted for its face validity. Data integrity was double-checked by a third reviewer (BHA). We extracted data on the following guideline characteristics: producing authority, named authors, country of origin, year of publication, consensus method, stakeholders involved, disease domain addressed in the CPG, description of the search strategy to identify evidence, inclusion/exclusion criteria of evidence, quality assessment instruments used, grading system used. We mapped out the clinical recommendations in each guideline and tabulated them into the following pre-specified domains: diagnosis in adolescents and adults; lifestyle interventions; management of menstrual irregularity, hirsutism, acne, and infertility; risk assessment for metabolic disease, cardiovascular disease, mental health, and cancer.