Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

Classified as probably not a substantial claim. May combine two claims.

Key updates include strengthening recognition of broader features of PCOS including metabolic risk factors, cardiovascular disease, sleep apnea, very high prevalence of psychological features, and high risk status for adverse outcomes during pregnancy.

“ii) strengthening recognition of broader features of PCOS including metabolic risk factors, cardiovascular disease, sleep apnea, very high prevalence of psychological features, and high risk status for adverse outcomes during pregnancy;”

May combine two claims.

The evidence in the assessment and management of PCOS has generally improved in the past five years, but remains of low to moderate quality.

“The evidence in the assessment and management of PCOS has generally improved in the past five years, but remains of low to moderate quality.”

Classified as probably not a substantial claim. May combine two claims.

Key updates include further refinement of individual diagnostic criteria, a simplified diagnostic algorithm and inclusion of anti-Müllerian hormone (AMH) levels as an alternative to ultrasound in adults only.

“Key updates include: i) further refinement of individual diagnostic criteria, a simplified diagnostic algorithm and inclusion of anti-Müllerian hormone (AMH) levels as an alternative to ultrasound in adults only;”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The technical evidence report and analyses (~6000 pages) underpins 77 evidence-based and 54 consensus recommendations, with 123 practice points.

“The technical evidence report and analyses (∼6000 pages) underpins 77 evidence-based and 54 consensus recommendations, with 123 practice points.”

Classified as probably not a substantial claim. May combine two claims.

Key updates include emphasizing the poorly recognized, diverse burden of disease and the need for greater healthcare professional education, evidence-based patient information, improved models of care and shared decision making to improve patient experience, alongside greater research.

“iii) emphasizing the poorly recognized, diverse burden of disease and the need for greater healthcare professional education, evidence-based patient information, improved models of care and shared decision making to improve patient experience, alongside greater research;”

Classified as probably not a substantial claim. May combine two claims.

Key updates include emphasizing evidence-based medical therapy and cheaper and safer fertility management.

“v) emphasizing evidence-based medical therapy and cheaper and safer fertility management.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the Guideline with an integrated evaluation program.

“Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the Guideline with an integrated evaluation program.”

Classified as probably not a substantial claim. May combine two claims.

Overall, recommendations are strengthened and evidence is improved, but remains generally low to moderate quality.

“Overall, recommendations are strengthened and evidence is improved, but remains generally low to moderate quality.”

Classified as probably not a substantial claim.

Key updates include maintained emphasis on healthy lifestyle, emotional wellbeing and quality of life, with awareness and consideration of weight stigma.

“iv) maintained emphasis on healthy lifestyle, emotional wellbeing and quality of life, with awareness and consideration of weight stigma;”

Classified as probably not a substantial claim.

Clinically available insulin assays are of limited clinical relevance.

“Insulin resistance is a pathophysiological factor in PCOS, however, clinically available insulin assays are of limited clinical relevance and should not be used in routine care (refer to 1.9.12).”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Metformin use may be associated with low vitamin B12 levels.

“Use may be associated with low vitamin B12 levels, especially in those with risk factors for low vitamin B12 (e.g., diabetes, post bariatric / metabolic surgery, pernicious anaemia, vegan diet etc.), where monitoring should be considered.”

Probably not a substantial claim: may not pass S4 (based).

There is no clinical advantage of using high dose ethinylestradiol (≥ 30 μg) versus low dose ethinylestradiol (< 30 μg) when treating hirsutism in adults with PCOS.

“Healthcare professionals could consider that there is no clinical advantage of using high dose ethinylestradiol (≥ 30 μg) versus low dose ethinylestradiol (< 30 μg) when treating hirsutism in adults with PCOS.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

There are no definitive criteria to define polycystic ovary morphology (PCOM) on ultrasound in adolescents, hence it is not recommended in adolescents.

“There are no definitive criteria to define polycystic ovary morphology (PCOM) on ultrasound in adolescents, hence it is not recommended in adolescents.”

Probably not a substantial claim: may not pass S4 (based).

Information, education and resources are a high priority for patients with PCOS.

“Information, education and resources are a high priority for patients with PCOS and should be provided in a respectful and empathic manner.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

PCOS prevalence is broadly similar across world regions, but may be higher in South East Asian and Eastern Mediterranean regions.

“Healthcare professionals should be aware that PCOS prevalence is broadly similar across world regions, but may be higher in South East Asian and Eastern Mediterranean regions.”

Probably not a substantial claim: may not pass S4 (based).

There are benefits to a healthy lifestyle even in the absence of weight loss.

“There are benefits to a healthy lifestyle even in the absence of weight loss.”

Probably not a substantial claim: may not pass S4 (based).

Female pattern hair loss and acne in isolation (without hirsutism) are relatively weak predictors of biochemical hyperandrogenism.

“Healthcare professionals could recognize that female pattern hair loss and acne in isolation (without hirsutism) are relatively weak predictors of biochemical hyperandrogenism.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Serum AMH is lower in those with higher BMI in the general population.

“Body mass index (BMI): Serum AMH is lower in those with higher BMI in the general population.”

Probably not a substantial claim: may not pass S4 (based).

Serum AMH should not yet be used in adolescents.

“Serum AMH should not yet be used in adolescents.”

Classified as probably not a substantial claim.

Specific types or doses of progestins, estrogens or combinations of COCP cannot currently be recommended.

“General population guidelines should be considered when prescribing COCP in adults and adolescents with PCOS as specific types or doses of progestins, estrogens or combinations of COCP cannot currently be recommended.”

• AssumptionRests on an assumption: General population guidelines are applicable to women with PCOS.

Probably not a substantial claim: may not pass S4 (based).

In patients with irregular menstrual cycles and hyperandrogenism, an ovarian ultrasound is not necessary for PCOS diagnosis.

“In patients with irregular menstrual cycles and hyperandrogenism, an ovarian ultrasound is not necessary for PCOS diagnosis.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The cardiometabolic risk in female first degree relatives of women with PCOS remains inconclusive.

“The cardiometabolic risk in female first degree relatives of women with PCOS remains inconclusive.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The presentation of PCOS may vary across ethnic groups.

“Healthcare professionals should be aware that the presentation of PCOS may vary across ethnic groups.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

PCOS is highly prevalent and has significantly higher psychological disorders.

“Funding bodies should recognize that PCOS is highly prevalent, and has significantly higher psychological disorders which should be prioritized and funded accordingly.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

The severity of hirsutism may vary by ethnicity but the prevalence of hirsutism appears similar across ethnicities.

“Healthcare professionals should consider that the severity of hirsutism may vary by ethnicity but the prevalence of hirsutism appears similar across ethnicities.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Serum AMH may vary across the menstrual cycle.

“Menstrual cycle day: Serum AMH may vary across the menstrual cycle.”

Probably not a substantial claim: may not pass S4 (based).

There is a lack of consistent evidence of physiological or behavioural lifestyle differences, related to weight, in women with PCOS compared to women without PCOS.

“Healthcare professionals and women with PCOS could consider that there is a lack of consistent evidence of physiological or behavioural lifestyle differences, related to weight, in women with PCOS compared to women without PCOS.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Medical therapy is generally not approved for use specifically in PCOS and recommended use is therefore evidence-based, but off-label.

“Medical therapy is generally not approved for use specifically in PCOS and recommended use is therefore evidence-based, but off-label.”

Classified as probably not a substantial claim.

PCOS and/or PCOS features have an adverse impact on quality of life in adults.

“Healthcare professionals and women should recognize the adverse impact of PCOS and/or PCOS features on quality of life in adults.”

Classified as probably not a substantial claim.

Features of PCOS can have a negative impact on body image.

“Healthcare professionals should be aware that features of PCOS can have a negative impact on body image.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Mild adverse effects, including gastrointestinal side-effects of metformin are generally dose dependent and self-limiting.

“Mild adverse effects, including gastrointestinal side-effects are generally dose dependent and self-limiting.”

May combine two claims.

Evidence was often stronger for the top ranked outcome, and high quality randomized controlled trials (RCTs) were often present, despite overall low quality of evidence.

“Evidence was often stronger for the top ranked outcome, and high quality randomized controlled trials (RCTs) were often present, despite overall low quality of evidence.”

Probably not a substantial claim: may not pass S4 (based).

Metformin and active lifestyle intervention have similar efficacy.

“Women should be informed that metformin and active lifestyle intervention have similar efficacy.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Psychological features are common and important components of PCOS.

“Psychological features are common and important components of PCOS that all healthcare professionals should be aware of.”

Probably not a substantial claim: may not pass S4 (based).

Pregnancy safety data are lacking for GLP-1 receptor agonists.

“Healthcare professionals should ensure concurrent effective contraception when pregnancy is possible for women who take GLP-1 receptor agonists, as pregnancy safety data are lacking.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Women with PCOS are at increased risk of cardiovascular disease and potentially of cardiovascular mortality, acknowledging that the overall risk of cardiovascular disease in pre-menopausal women is low.

“Women with PCOS should be considered at increased risk of cardiovascular disease and potentially of cardiovascular mortality, acknowledging that the overall risk of cardiovascular disease in pre-menopausal women is low.”

Probably not a substantial claim: may not pass S4 (based).

Evidence-based strategies for shared decision making and for sharing news (such as the SPIKES framework) are readily available.

“Evidence-based strategies for shared decision making and for sharing news (such as the SPIKES framework) are readily available and should be used to inform PCOS care.”

Probably not a substantial claim: may not pass S4 (based).

Serum AMH could be used for defining PCOM in adults.

“Serum anti-Müllerian hormone (AMH) could be used for defining PCOM in adults.”

Classified as probably not a substantial claim.

Serum AMH should not be used as a single test for the diagnosis of PCOS.

“We recommend that serum AMH should not be used as a single test for the diagnosis of PCOS.”

Classified as probably not a substantial claim.

The combination of COCP and metformin offers little additional clinical benefit over COCP or metformin alone, in adults with PCOS with a BMI ≤ 30 kg/m2.

“The combination of COCP and metformin could be considered to offer little additional clinical benefit over COCP or metformin alone, in adults with PCOS with a BMI ≤ 30 kg/m2.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Either serum AMH or ultrasound may be used to define PCOM; however, both tests should not be performed to limit overdiagnosis.

“Either serum AMH or ultrasound may be used to define PCOM; however, both tests should not be performed to limit overdiagnosis.”

Classified as probably not a substantial claim.

Lifestyle intervention (exercise alone or multicomponent diet combined with exercise and behavioural strategies) improves metabolic health including central adiposity and lipid profile in women with PCOS.

“Lifestyle intervention (exercise alone or multicomponent diet combined with exercise and behavioural strategies) should be recommended for all women with PCOS, for improving metabolic health including central adiposity and lipid profile.”

• AssumptionRests on an assumption: The benefits of lifestyle intervention observed in the general population apply to women with PCOS.

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Both clinical and biochemical hyperandrogenism persist in the postmenopause for women with PCOS.

“Healthcare professionals could consider that both clinical and biochemical hyperandrogenism persist in the postmenopause for women with PCOS.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Fathers and brothers of women with PCOS may have an increased prevalence of metabolic syndrome, type 2 diabetes, and hypertension.

“Healthcare professionals could consider that fathers and brothers of women with PCOS may have an increased prevalence of metabolic syndrome, type 2 diabetes, and hypertension.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

This is a living Guideline with annual evidence review in rapidly evolving areas.

“Finally, we note that this is a living Guideline with annual evidence review in rapidly evolving areas.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Certainty of evidence varied across outcomes within each question, and evidence certainty reflects the lowest certainty for the critical outcomes.

“Notably, certainty of evidence varied across outcomes within each question. Here evidence certainty reflects the lowest certainty for the critical outcomes.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Serum AMH generally peaks between the ages of 20-25 years in the general population.

“Age: Serum AMH generally peaks between the ages of 20–25 years in the general population.”

May combine two claims. The quote only partly states this claim.

IVM/ICSI has no risk of ovarian hyperstimulation syndrome but a lower cumulative live birth rate compared to stimulated IVF/ICSI.

“The use of in vitro maturation (IVM) and ICSI could be considered in women with PCOS as an alternative to a stimulated IVF/ICSI cycle, where an embryo is frozen and replaced in a subsequent embryo transfer cycle, acknowledging there is no risk of ovarian hyperstimulation syndrome, but a lower cumulative live birth rate.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

In women with anovulatory PCOS, the use of IVF is effective and when elective single embryo transfer is used, multiple pregnancies can be minimized.

“In women with anovulatory PCOS, the use of IVF is effective and when elective single embryo transfer is used, multiple pregnancies can be minimized.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Laser is relatively ineffective in women with blond, grey or white hair.

“Laser is relatively ineffective in women with blond, grey or white hair.”

Probably not a substantial claim: may not pass S4 (based).

Routinely available measures of insulin resistance are inaccurate.

“routinely available measures of insulin resistance are inaccurate”

Classified as probably not a substantial claim.

Overall, evidence in PCOS is low to moderate quality.

“Overall, evidence in PCOS is low to moderate quality.”

Classified as probably not a substantial claim. May combine two claims.

Metabolic risk factors, diabetes, cardiovascular disease, and sleep disorders are all increased in PCOS.

“These include metabolic risk factors, diabetes, cardiovascular disease, and sleep disorders, which are all increased in PCOS.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Side effects of metformin are mostly mild, transient gastrointestinal symptoms and are not worse in pregnancy.

“Side effects of metformin are mostly mild, transient gastrointestinal symptoms and are not worse in pregnancy.”

Classified as probably not a substantial claim.

There is no one specific diet or physical activity regimen that has benefits over others in PCOS.

“there is no one specific regimen that has benefits over others in PCOS.”

Classified as probably not a substantial claim.

Letrozole improves ovulation, clinical pregnancy and live birth rates compared to clomiphene citrate in women with PCOS with anovulatory infertility and no other infertility factors.

“Letrozole should be used rather than clomiphene citrate in women with PCOS with anovulatory infertility and no other infertility factors to improve ovulation, clinical pregnancy and live birth rates.”

Probably not a substantial claim: may not pass S4 (based).

Excess weight has an adverse impact on clinical pregnancy, miscarriage, and live birth rates following infertility treatment in women with PCOS.

“Women with PCOS should be counselled on the adverse impact of excess weight on clinical pregnancy, miscarriage, and live birth rates, following infertility treatment.”

May combine two claims.

Pregnant women with PCOS have an increased risk of intrauterine growth restriction, small for gestational age babies and low birth weight.

“Intrauterine growth restriction, small for gestational age babies and low birth weight.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Metformin reduces preterm delivery and limits excess gestational weight gain in pregnant women with PCOS in some circumstances (e.g., risk for preterm birth).

“Metformin could be considered in some circumstances (e.g., risk for preterm birth) to reduce preterm delivery and limit excess gestational weight gain, in pregnant women with PCOS.”

Probably not a substantial claim: may not pass S4 (based).

Side effects and safety are not known for inositol.

“Side effects and safety are not known for inositol.”

Probably not a substantial claim: may not pass S4 (based).

Dissatisfaction with PCOS diagnosis and care is high.

“Dissatisfaction with PCOS diagnosis and care is high”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Mechanical laser therapy is effective for hair reduction in some subgroups.

“Mechanical laser therapy is effective for hair reduction in some subgroups”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Mechanical laser and light therapies reduce facial hirsutism and related depression, anxiety, and quality of life in women with PCOS.

“Mechanical laser and light therapies should be considered for reducing facial hirsutism and for related depression, anxiety, and quality of life in women with PCOS.”

Classified as probably not a substantial claim. May combine two claims.

In adolescents, both hyperandrogenism and ovulatory dysfunction are required for PCOS diagnosis, with ultrasound and AMH not recommended due to poor specificity.

“In adolescents, both hyperandrogenism and ovulatory dysfunction are required, with ultrasound and AMH not recommended due to poor specificity.”

Probably not a substantial claim: may not pass S4 (based).

PCOS is a high-risk condition in pregnancy.

“PCOS should be considered a high-risk condition in pregnancy”

Classified as probably not a substantial claim.

AMH can now be used instead of ultrasound for PCOS diagnosis.

“here in 2023, alternatively anti-Müllerian hormone (AMH) can now be used instead of ultrasound.”

May combine two claims.

There is an increased premenopausal risk of endometrial cancer in PCOS, whilst absolute risks remain low.

“An increased premenopausal risk of endometrial cancer should also be recognized, whilst absolute risks remain low.”

Probably not a substantial claim: may not pass S4 (based).

Adjunct metformin therapy reduces the risk of developing ovarian hyperstimulation syndrome and miscarriage in women with PCOS undergoing IVF/ICSI treatment with GnRH agonist long protocol.

“Adjunct metformin therapy could be used before and/or during FSH ovarian stimulation in women with PCOS undergoing IVF/ICSI treatment with GnRH agonist long protocol, to reduce the risk of developing ovarian hyperstimulation syndrome and miscarriage.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Metformin has greater efficacy than inositol, which offers limited clinical benefits in PCOS.

“Metformin is recommended primarily for metabolic features and has greater efficacy than inositol, which offers limited clinical benefits in PCOS.”

Probably not a substantial claim: may not pass S4 (based).

Assisted reproductive technology in women with PCOS does not confer additional risk of miscarriage, preterm birth, impaired fetal growth, and caesarean section over that observed in women without PCOS.

“Assisted reproductive technology in women with PCOS should be considered as not conferring additional risk of miscarriage, preterm birth, impaired fetal growth, and caesarean section, over that observed in women without PCOS.”

Classified as probably not a substantial claim. May combine two claims.

Inositol has limited harm, potential for improvement in metabolic measures, yet limited clinical benefits including in ovulation, hirsutism or weight.

“Inositol (in any form) could be considered in women with PCOS based on individual preferences and values, noting limited harm, potential for improvement in metabolic measures, yet with limited clinical benefits including in ovulation, hirsutism or weight.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Women with PCOS do not have an increased risk of large for gestational age babies, macrosomia and instrumental delivery.

“Women with PCOS should be considered as not having an increased risk of large for gestational age babies, macrosomia and instrumental delivery.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Bariatric/metabolic surgery improves weight loss, hypertension, diabetes (prevention and treatment), hirsutism, irregular menstrual cycles, ovulation, and pregnancy rates in women with PCOS.

“Bariatric/ metabolic surgery could be considered to improve weight loss, hypertension, diabetes (prevention and treatment), hirsutism, irregular menstrual cycles, ovulation, and pregnancy rates in women with PCOS.”

• AssumptionRests on an assumption: PCOS is a metabolic condition.

Probably not a substantial claim: may not pass S4 (based).

The addition of combined oral contraceptive pills (COCP), with or without anti-androgens, to laser treatment may provide greater hair reduction and maintenance compared to laser alone.

“The addition of combined oral contraceptive pills (COCP), with or without anti-androgens, to laser treatment may provide greater hair reduction and maintenance compared to laser alone.”

May combine two claims.

Live birth rate, clinical pregnancy rate per patient and ovulation rate per cycle are higher with gonadotrophins than with clomiphene citrate.

“Live birth rate, clinical pregnancy rate per patient and ovulation rate per cycle are higher with gonadotrophins than with clomiphene citrate.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Regional health system variation was considered and acknowledged, with a further process for guideline and translation resource adaptation provided.

“Regional health system variation was considered and acknowledged, with a further process for guideline and translation resource adaptation provided.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Processes aligned with all elements of the AGREE-II tool for quality guideline assessment.

“Processes aligned with all elements of the AGREE-II tool for quality guideline assessment (Brouwers er al., 2010), with extensive evidence synthesis and meta-analysis.”

Classified as probably not a substantial claim.

Extensive evidence synthesis was completed.

“Extensive evidence synthesis was completed.”

Probably not a substantial claim: may not pass S3 (load-bearing).

AGREEII-compliant processes were followed.

“Appraisal of Guidelines for Research and Evaluation-II (AGREEII)-compliant processes were followed.”

May combine two claims.

PCOS aetiology is complex and clinical presentation is heterogeneous with reproductive, metabolic, and psychological features.

“PCOS aetiology is complex; and clinical presentation is heterogeneous with reproductive, metabolic, and psychological features (Teede et al., 2010; Azziz et al., 2016).”

• cites Teede et al., 2010 sourceNot checked yet

  Not checked in the free run.

• cites Azziz et al., 2016 sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Best practice evidence-based guideline development methods were applied.

“Best practice evidence-based guideline development methods were applied and are detailed in the full Guideline and the technical report, which are available online (www.monash.edu/medicine/mchri/pcos) (Misso and Teede, 2012).”

May combine two claims.

Women internationally experience delayed diagnosis and dissatisfaction with care.

“Women internationally experience delayed diagnosis and dissatisfaction with care (Gibson-Helm er al., 2017; Dokras et al., 2017; Teede et al., 2014).”

• cites Gibson-Helm er al., 2017Not checked yet

  Not checked in the free run.

• cites Dokras et al., 2017 sourceNot checked yet

  Not checked in the free run.

• cites Teede et al., 2014 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The guideline and translation program were developed with full consumer participation at all stages including priority topics and outcomes for those with PCOS.

“The guideline and translation program were developed with full consumer participation at all stages including priority topics and outcomes for those with PCOS.”

Probably not a substantial claim: may not pass S3 (load-bearing).

PCOS prevalence is between 10% and 13%.

“PCOS prevalence is between 10 to 13%, as confirmed in the guideline process (Teede et al., 2010; Azziz et al., 2016).”

• cites Teede et al., 2010 sourceNot checked yet

  Not checked in the free run.

• cites Azziz et al., 2016 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The 2023 International Evidence-based Guideline update reengaged the 2018 network across professional societies and consumer organizations, with multidisciplinary experts and women with PCOS directly involved at all stages.

“The 2023 International Evidence-based Guideline update reengaged the 2018 network across professional societies and consumer organizations, with multidisciplinary experts and women with PCOS directly involved at all stages.”

Classified as probably not a substantial claim. May combine two claims.

The GRADE framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength and diversity and inclusion were considered throughout.

“The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength and diversity and inclusion were considered throughout.”

Classified as probably not a substantial claim.

Any diet composition consistent with population guidelines for healthy eating will have health benefits.

“Any diet composition consistent with population guidelines for healthy eating will have health benefits and, within this, healthcare professionals should advise sustainable healthy eating tailored to individual preferences and goals.”

May combine two claims.

Integrity assessment was integrated into guideline evidence synthesis processes and followed the Research Integrity in Guideline Development (RIGID) framework, with studies assessed against criteria from the Research Integrity Assessment (RIA) tool and the Trustworthiness in RAndomised Controlled Trials (TRACT) checklist.

“Integrity assessment was integrated into guideline evidence synthesis processes and followed the Research Integrity in Guideline Development (RIGID) framework, with studies assessed against criteria from the Research Integrity Assessment (RIA) tool and the Trustworthiness in RAndomised Controlled Trials (TRACT) checklist (Mousa et al., 2023; Weibel at al., 2023; Mol et al., 2023).”

Classified as probably not a substantial claim.

Any physical activity consistent with population guidelines will have health benefits.

“Any physical activity consistent with population guidelines will have health benefits and, within this, healthcare professionals should advise sustainable physical activity based on individual preferences and goals.”

Classified as probably not a substantial claim.

In combination with the COCP, metformin may be most beneficial in high metabolic risk groups including those with a BMI >30 kg/m2, diabetes risk factors, impaired glucose tolerance or high-risk ethnic groups.

“In combination with the COCP, metformin may be most beneficial in high metabolic risk groups including those with a BMI >30 kg/m2, diabetes risk factors, impaired glucose tolerance or high-risk ethnic groups.”

Classified as probably not a substantial claim.

Evidence quality was categorized according to the GRADE framework, with judgments about quality incorporating risk of bias, inconsistency, indirectness, imprecision and other considerations.

“Evidence quality was categorized according to the GRADE framework, with judgments about the quality of the included studies and/or synthesized evidence incorporating risk of bias, inconsistency, indirectness, imprecision and any other considerations (e.g., publication bias) that may influence evidence quality.”

Probably not a substantial claim: may not pass S4 (based).

Many women with PCOS will have underlying mechanisms that drive greater longitudinal weight gain and higher BMI.

“Whilst the specific mechanisms are unclear, it is recognized that many women with PCOS will have underlying mechanisms that drive greater longitudinal weight gain and higher BMI which may: Underpin greater challenges with weight management.”

Classified as probably not a substantial claim.

Evidence synthesis methods followed best practice.

“Evidence synthesis methods are outlined in the full guideline and followed best practice (Brouwers et al., 2010; National Health and Medical Research Council, 2009; National Health and Medical Research Council, 2007).”

Classified as probably not a substantial claim. May combine two claims.

All recommendations were formulated after an assessment of the best available evidence, multidisciplinary clinical expertise, consumer preferences and structured review by five GDGs.

“All recommendations were formulated after an assessment of the best available evidence, multidisciplinary clinical expertise, consumer preferences and structured review by five GDGs.”