When should I consider referring a patient with PCOS for specialist evaluation or treatment?

Consider referring a patient with polycystic ovary syndrome (PCOS) for specialist evaluation or treatment in the following situations:

• If the patient has symptoms of obstructive sleep apnoea syndrome (OSAS) and a positive screening questionnaire (e.g., STOP-Bang), refer to a specialist centre for further investigation and treatment.
• If there are psychological disorders such as depression, anxiety, psychosexual problems, negative body image, or eating disorders that require specialist management.
• If the patient is pregnant or planning pregnancy and requires a 75-g oral glucose tolerance test (OGTT) or management of pregnancy complications related to PCOS.
• If there is suspicion of endometrial cancer, especially in women with prolonged amenorrhoea, abnormal vaginal bleeding, or excess weight, consider referral for transvaginal ultrasound and/or endometrial biopsy.
• If dyslipidaemia is present and requires treatment beyond primary care management.
• If glycaemic status assessment reveals impaired fasting glucose or impaired glucose tolerance requiring specialist diabetes care.
• If infertility related to PCOS is present and requires specialist fertility assessment and treatment.
• In adolescents, consider referral to a dietitian for weight management if overweight or obese, and seek specialist advice before initiating metformin for PCOS without diabetes.

These referral considerations align with the need for multidisciplinary management of PCOS complications and optimization of long-term health outcomes.

References: NICE CKS, NICE CG156