September is Polycystic Ovary Syndrome Awareness Month and is an excellent time to focus on the latest Cochrane evidence.

Polycystic ovary syndrome (PCOS) is a common condition affecting 8% to 13% of women in reproductive age. There are three main PCOS features

• menstrual cycle problems, such as irregular periods or having no periods (meaning the ovaries do not release eggs)
• high levels of "male" hormones – hirsutism (excessive hair growth) or elevated testosterone
• polycystic ovaries – the ovaries contain many fluid-filled sacs (follicles) that surround the eggs.

Being overweight worsens the clinical features of PCOS. These clinical features include reproductive issues such as irregular menstrual cycles reduced frequency of ovulation, reduced fertility, polycystic ovaries on ultrasound and high levels of male hormones such as testosterone. The elevated hormone levels can cause unwanted facial or body hair growth and acne. PCOS is also associated with metabolic features, with risk factors for diabetes and cardiovascular disease including high levels of insulin or insulin resistance and abnormal cholesterol levels. PCOS affects quality of life and can worsen anxiety and depression either due to its symptoms or due to the diagnosis of a chronic disease. There is no cure for PCOS, but symptoms can be treated.

The Cochrane Gynaecology and Fertility Group  is concerned with the systematic evaluation of the management and treatment of menstrual disorders and subfertility. The CGF carries out extensive searches for all relevant randomised controlled trials (RCTs) both published and unpublished; scrutinises each trial for its relevance and quality; critically appraises trials; draws conclusions based on pooling data about how their net result should be applied in healthcare; and produces structured reports (systematic reviews) for widespread dissemination to health care providers and planners, and to consumers.

Cochrane Gynaecology and Fertility Group (CGF) has published 19 systematic reviews on the effectiveness and safety of various interventions for the treatment and management of PCOS.

Here is the curated list of their Cochrane systematic reviews on PCOS:

• Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome
• Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome – Blogshot available
• Metformin for ovulation induction (excluding gonadotrophins) in women with polycystic ovary syndrome - Blogshot available
• Metformin during ovulation induction with gonadotrophins followed by timed intercourse or intrauterine insemination for subfertility associated with polycystic ovary syndrome
• Gonadotrophins for ovulation induction in women with polycystic ovarian syndrome - Blogshot available 
• Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome
• Ovarian surgery for symptom relief in women with polycystic ovary syndrome
• Lifestyle changes in women with polycystic ovary syndrome - Blogshot available 
• Acupuncture for polycystic ovarian syndrome
• Inositol for subfertile women with polycystic ovary syndrome
• In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction
• Chinese herbal medicine for subfertile women with polycystic ovarian syndrome

Review updates in development

• Statins for women with polycystic ovary syndrome not actively trying to conceive
• Aromatase inhibitors for subfertile women with polycystic ovary syndrome - Blogshot available 
• Ultrasound-guided transvaginal ovarian needle drilling for clomiphene-resistant polycystic ovarian syndrome in subfertile women

Stable reviews

• Antidepressants for polycystic ovary syndrome
• Long versus short course treatment with metformin and clomiphene citrate for ovulation induction in women with PCOS
• Pulsatile gonadotrophin releasing hormone for ovulation induction in subfertility associated with polycystic ovary syndrome
• Clomiphene and other antioestrogens for ovulation induction in polycystic ovarian syndrome