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Systematic Reviews
Published in: Systematic Reviews 1/2015

Open Access 01-12-2015 | Protocol

The effectiveness and safety of treatments used for polycystic ovarian syndrome management in adolescents: a systematic review and network meta-analysis protocol

Authors: Reem A. Al Khalifah, Iván D. Flórez, Brittany Dennis, Binod Neupane, Lehana Thabane, Ereny Bassilious

Published in: Systematic Reviews | Issue 1/2015

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Abstract

Background

Polycystic ovarian syndrome (PCOS) is a common reproductive endocrine disease that is seen among adolescent women. Currently, there is limited evidence to support treatment options leading to considerable variation in practice among healthcare specialists. The objective of this study is to review and synthesize all the available evidence on treatment options for PCOS among adolescent women.

Methods/design

We will conduct a systematic review of all randomized controlled trials evaluating the use of metformin, oral contraceptive pills as monotherapy, or as combination with pioglitazone, spironolactone, flutamide, and lifestyle interventions in the treatment of PCOS in adolescent women ages 11 to 19 years. The primary outcome measures are menstrual regulation and change hirsutism scores. The secondary outcome measures include acne scores, prevalence of dysglycaemia, BMI, lipid profile, total testosterone level, and adverse events. We will perform literature searches through Ovid Medline, Ovid Embase, and Cochrane Central Register of Controlled Trials (CENTRAL), and gray literature resources. Two reviewers will independently screen titles and abstracts of identified citations, review the full texts of potentially eligible trials, extract information from eligible trials, and assess the risk of bias and quality of the evidence independently. Results of this review will be summarized narratively and quantitatively as appropriate. We will perform a multiple treatment comparison using network meta-analysis to estimate the pooled direct and indirect effects for all PCOS interventions on outcomes if adequate data is available.

Discussion

PCOS treatment poses a clinical challenge to the patients and physicians. This is the first systematic review and network meta-analysis for PCOS treatment in adolescents. We expect that our results will help improve patient care, unify the treatment approaches among specialists, and encourage research for other therapeutic options.

Systematic review registration

PROSPERO CRD42015016148
Appendix
Available only for authorised users
Literature
1.
Li R, Zhang Q, Yang D, Li S, Lu S, Wu X, et al. Prevalence of polycystic ovary syndrome in women in China: a large community-based study. Hum Reprod. 2013;28(9):2562–9.PubMed
2.
Christensen SB, Black MH, Smith N, Martinez MM, Jacobsen SJ, Porter AH, et al.  Prevalence of polycystic ovary syndrome in adolescents. Fertil Steril. 2013;100(2):470–7.PubMed
3.
Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod. 2012;27(10):3067–73.PubMed
4.
5.
Kumarapeli V, Seneviratne Rde A, Wijeyaratne C. Health-related quality of life and psychological distress in polycystic ovary syndrome: a hidden facet in South Asian women. BJOG. 2011;118(3):319–28.PubMed
6.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19–25.
7.
Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009;91(2):456–88.PubMed
8.
Zawadski J, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens J, Haseltine F, Merriam G, editors. Polycystic Ovary Syndrome. 1st ed. Boston: Blackwell Scientific Publications; 1992. p. 377–84.
9.
Hardy TS, Norman RJ. Diagnosis of adolescent polycystic ovary syndrome. Steroids. 2013;78(8):751–4.PubMed
10.
Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4565–92.PubMed
11.
Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352(12):1223–36.PubMed
12.
Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nat Rev Endocrinol. 2011;7(4):219–31.PubMed
13.
Pauli JM, Raja-Khan N, Wu X, Legro RS. Current perspectives of insulin resistance and polycystic ovary syndrome. Diabet Med. 2011;28(12):1445–54.PubMed
14.
Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997;18(6):774–800.PubMed
15.
Rehme MF, Pontes AG, Goldberg TB, Corrente JE, Pontes A. Clinical manifestations, biochemical, ultrasonographic and metabolic of polycystic ovary syndrome in adolescents. Rev Bras Ginecol Obstet. 2013;35(6):249–54.PubMed
16.
Li L, Chen X, He Z, Zhao X, Huang L, Yang D. Clinical and metabolic features of polycystic ovary syndrome among Chinese adolescents. J Pediatr Adolesc Gynecol. 2012;25(6):390–5.PubMed
17.
Bekx MT, Connor EC, Allen DB. Characteristics of adolescents presenting to a multidisciplinary clinic for polycystic ovarian syndrome. J Pediatr Adolesc Gynecol. 2010;23(1):7–10.PubMed
18.
Gooding HC, Milliren C, St Paul M, Mansfield MJ, DiVasta A. Diagnosing dysglycemia in adolescents with polycystic ovary syndrome. J Adolesc Health. 2014;55(1):79–84.PubMed
19.
Flannery CA, Rackow B, Cong X, Duran E, Selen DJ, Burgert TS. Polycystic ovary syndrome in adolescence: impaired glucose tolerance occurs across the spectrum of BMI. Pediatr Diabetes. 2013;14(1):42–9.PubMed
20.
Palmert MR, Gordon CM, Kartashov AI, Legro RS, Emans SJ, Dunaif A. Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome. J Clin Endocrinol Metab. 2002;87(3):1017–23.PubMed
21.
Mani H, Levy MJ, Davies MJ, Morris DH, Gray LJ, Bankart J, et al. Diabetes and cardiovascular events in women with polycystic ovary syndrome: a 20-year retrospective cohort study. Clin Endocrinol. 2013;78(6):926–34.
22.
Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman's long-term health using data linkage. J Clin Endocrinol Metab. 2015;100(3):911–9. jc20143886.PubMed
23.
Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update. 2006;12(6):673–83.PubMed
24.
Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(5):748–58.PubMedPubMedCentral
25.
Shen CC, Yang AC, Hung JH, Hu LY, Tsai SJ. A nationwide population-based retrospective cohort study of the risk of uterine, ovarian and breast cancer in women with polycystic ovary syndrome. Oncologist. 2015;20(1):45–9.PubMed
26.
Gottschau M, Kjaer SK, Jensen A, Munk C, Mellemkjaer L. Risk of cancer among women with polycystic ovary syndrome: a Danish cohort study. Gynecol Oncol. 2015;136(1):99–103.PubMed
27.
Jones GL, Hall JM, Lashen HL, Balen AH, Ledger WL. Health-related quality of life among adolescents with polycystic ovary syndrome. J Obstet Gynecol Neonatal Nurs. 2011;40(5):577–88.PubMed
28.
Crete J, Adamshick P. Managing polycystic ovary syndrome: what our patients are telling us. J Holist Nurs. 2011;29(4):256–66.PubMed
29.
Nasiri Amiri F, Ramezani Tehrani F, Simbar M, Montazeri A, Mohammadpour Thamtan RA. The experience of women affected by polycystic ovary syndrome: a qualitative study from Iran. Int J Endocrinol Metab. 2014;12(2):e13612.PubMedPubMedCentral
30.
Conway G, Dewailly D, Diamanti-Kandarakis E, et al. European survey of diagnosis and management of the polycystic ovary syndrome: results of the ESE PCOS Special Interest Group's Questionnaire. Eur J Endocrinol. 2014;171(4):489–98.PubMed
31.
Auble B, Elder D, Gross A, Hillman JB. Differences in the management of adolescents with polycystic ovary syndrome across pediatric specialties. J Pediatr Adolesc Gynecol. 2013;26(4):234–8. Date of Publication: August 2013.; 2013.PubMed
32.
AlKhalifah R, Florez ID, Thabane L, Dennis B, Bassilious E. Metformin versus oral contraceptive pills for the management of polycystic ovarian syndrome in adolescents: systematic review and meta-analysis. PROSPERO International prospective register of systematic reviews2015.
33.
Mills EJ, Thorlund K, Ioannidis JP. Demystifying trial networks and network meta-analysis. BMJ (Clinical research ed). 2013;346:f2914.
34.
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. Bmj. 2015;349:g7647.
35.
Sacks D; Canadian Paediatric Society. Age limits and adolescents. Paediatrics & Child Health. Nov 2003;8(9):577.
36.
37.
Collaboration TC. The Cochrane handbook for systematic reviews of interventions version 5.1.0. 2011.
38.
39.
Cornell JE, Mulrow CD, Localio R, et al. Random-effects meta-analysis of inconsistent effects: a time for change. Ann Intern Med. 2014;160(4):267–70.PubMed
40.
Gelman A, Rubin DB. Inference from iterative simulation using multiple sequences. Stat Sci. 1992;7:457–72.
41.
Lumley T. Network meta-analysis for indirect treatment comparisons. Stat Med. 2002;21(16):2313–24.PubMed
42.
Higgins J. Identifying and addressing inconsistency in network meta-analysis. Paper presented at: Cochrane comparing multiple interventions methods group Oxford training event 2013.
43.
Dias S, Welton NJ, Caldwell DM, Ades AE. Checking consistency in mixed treatment comparison meta-analysis. Stat Med. 2010;29(7–8):932–44.PubMed
44.
Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64(2):163–71.PubMed
45.
Welton NJ, Caldwell DM, Adamopoulos E, Vedhara K. Mixed treatment comparison meta-analysis of complex interventions: psychological interventions in coronary heart disease. Am J Epidemiol. 2009;169(9):1158–65.PubMed
46.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–94.
47.
Guyatt GH, Oxman AD, Kunz R, Woodcock J, Brozek J, Helfand M, et al. GRADE guidelines: 8. Rating the quality of evidence—indirectness. J Clin Epidemiol. 2011;64(12):1303–10.PubMed
48.
Puhan MA, Schunemann HJ, Murad MH, et al. A GRADE working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ. 2014;349:g5630.PubMed
49.
Costello M, Shrestha B, Eden J, Sjoblom P, Johnson N. Insulin-sensitising drugs versus the combined oral contraceptive pill for hirsutism, acne and risk of diabetes, cardiovascular disease, and endometrial cancer in polycystic ovary syndrome. Cochrane Database Syst Rev 2007;1:CD005552.
Metadata
Title
The effectiveness and safety of treatments used for polycystic ovarian syndrome management in adolescents: a systematic review and network meta-analysis protocol
Authors
Reem A. Al Khalifah
Iván D. Flórez
Brittany Dennis
Binod Neupane
Lehana Thabane
Ereny Bassilious
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2015
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-015-0105-4

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