Different consensus statements of PCO -Over last three decades.

Let us another consensus on PCO . We are aware that there were many conferences and consensus in the decades of ninties and thereafter .There have been many changes in the definition and criteria of PCOS

A)      Definition No 1:-NIH In 1990 a consensus workshop sponsored by the NIH/NICHD suggested that a person has PCOS if they have all of the following: oligoovulation signs of androgen excess (clinical or biochemical)

Exclusion of other disorders that can result in menstrual irregularity and hyperandrogenism

A)      Rotterdam In 2003:In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam, the Netherlands, in 2003 focused on diagnostic criteria indicated PCOS to be present if any 2 out of 3 criteria are met, in the absence of other entities that might cause these findings

Oligoovulation and/or anovulation excess androgen activity,::Polycystic ovaries (by gynecologic ultrasound):: The Rotterdam definition is wider, including many more women, the most notable ones being women without androgen excess. Critics say that findings obtained from the study of women with androgen excess cannot necessarily be extrapolated to women without androgen excess.^\ .Rotterdam diagnostic criteria –originally required as we all know two of Oligo or anovulation, Clinical and / or biochemical signs of   hyperandrogenism. Rotterdam In 2003  .. In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met, in the absence of other entities that might cause these findings.

    Androgen Excess PCOS Society, In 2006, the Androgen Excess PCOS Society suggested a tightening of the diagnostic criteria to all of the following: excess androgen activity, oligoovulation/anovulation and/or polycystic ovaries exclusion of other entities that would cause excess androgen activity) . Thessaloniki, Greece, in 2007 dealt with infertility management in PCOS, the second in NIH In 1990 a consensus workshop sponsored by the NIH/NICHD suggested that a person has PCOS if they have all of the following:^[56]

oligoovulation

signs of androgen excess (clinical or biochemical)

exclusion of other disorders that can result in menstrual irregularity and hyperandrogenism

oligoovulation and/or anovulation

excess androgen activity

polycystic ovaries (by gynecologic ultrasound)

The Rotterdam definition is wider, including many more women, the most notable ones being women without androgen excess. Critics say that findings obtained from the study of women with androgen excess cannot necessarily be extrapolated to women without androgen excess. Androgen Excess PCOS Society

In 2006, the Androgen Excess PCOS Society suggested a tightening of the diagnostic criteria to all of the following:^[17]

excess androgen activity

oligoovulation/anovulation and/or polycystic ovaries

exclusion of other entities that would cause excess androgen activity

Standard assessment :--

 Rotterdam, the Netherlands, in 2003 focused on diagnostic criteria

for PCOS); 3) Thessaloniki, Greece, in 2007

dealt with infertility management in PCOS . Assessment of Cardiovascular Risk and Prevention of Cardiovascular Disease in Women with the Polycystic Ovary Syndrome: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. Only studies comparing PCOS with control patients were included. All electronic databases were searched; reviews included individual studies/databases, systematic reviews, abstracts, and expert data. Articles were excluded if other hyperandrogenic disorders were not excluded, PCOS diagnosis was unclear, controls were not described, or methodology precluded evaluation. Inclusion/exclusion criteria were confirmed by at least two reviewers and arbitrated by a third.

Consensus Process: Systematic reviews of CVD risk factors were compiled and submitted for approval to the AE-PCOS Society Board.

Conclusions: Women with PCOS with obesity, cigarette smoking, dyslipidemia, hypertension, impaired glucose tolerance, and subclinical vascular disease are at risk, whereas those with metabolic syndrome and/or type 2 diabetes mellitus are at high risk for CVD. Body mass index, waist circumference, serum lipid/glucose, and blood pressure determinations are recommended for all women with PCOS, as is oral glucose tolerance testing in those with obesity, advanced age, personal history of gestational diabetes, or family history of type 2 diabetes mellitus. Mood disorder assessment is suggested in all PCOS patients. Lifestyle management is recommended for primary CVD prevention, targeting low-density and non-high-density lipoprotein cholesterol and adding insulin-sensitizing and other drugs if dyslipidemia or other risk factors persist.

The conclusions of these meetings were subsequently For instance  International evidence    based guideline was released on July 19, 2018  for the assessment    and management of PCOS addressing  psychological metabolic  and reproductive features   of PCOS. :-Polycystic ovary  syndrome  is a significant public health issue affecting reproductive metabolic and psychological  health   of women PCOS is one of the most common endocrinopathy  in reproductive aged  women with  prevalence of  8%-15%   . Women  with PCOS  present with  diverse   features including reproductive    metabolic   and   psychological  features

Diagnosis   of PCOS   remain controversial and assessment   and management are inconsistent . Previous    guidelines locked  rigorous evidence   based processes did not  engage consumer and   international multidisciplinary     perspectives or were   outdated. In this context  international evidence    based guideline was released on July 19, 2018  for the assessment    and management of PCOS addressing  psychological metabolic  and reproductive features   of PCOS,. In total 37  societies and organizations covering  71  countries  engaged in the process.