New ESHRE PCOS Guideline: What the Updates Mean for You
The European Society of Human Reproduction and Embryology (ESHRE), together with international partners, has released an updated evidence-based guideline for the diagnosis and management of Polycystic Ovary Syndrome (PCOS). This update reflects important new research and aims to improve diagnosis, treatment, and long-term health outcomes for women with PCOS.
Here’s a summary of what’s new - and what it means for patients and clinicians in New Zealand.
A More Accurate and Patient-Centred Approach to Diagnosis
Clearer diagnostic criteria
The updated guideline continues to recommend the Rotterdam criteria, but provides clearer definitions for:
Irregular ovulation
Clinical or biochemical hyperandrogenism (e.g., acne, hirsutism, elevated androgens)
Polycystic ovarian morphology on ultrasound
No ultrasound for adolescents
For young people under 8 years post–menarche, ultrasound is not recommended for diagnosis. Instead, irregular cycles and signs of androgen excess are the focus.
Anti-Müllerian Hormone (AMH) use is clarified
AMH may be used as an alternative to ultrasound in adults, but cannot diagnose PCOS alone - it must be interpreted within the clinical picture.
A Stronger Emphasis on Metabolic and Long-Term Health
All women with PCOS should have metabolic screening
This includes:
Glucose tolerance or HbA1c
Lipids
Blood pressure
Weight/BMI and waist circumference
Women with PCOS have higher lifetime risks of type 2 diabetes, cardiovascular disease, and sleep apnoea, and early identification is key.
Regular follow-up is recommended
Metabolic screening should be repeated every 1–3 years, depending on personal risk factors.
Updated Treatment Recommendations
Lifestyle and wellbeing first
The guideline reinforces that lifestyle interventions (nutrition, physical activity, sleep, stress management) are beneficial for all women with PCOS, regardless of weight.
The focus is on health, not numbers, with a shift away from weight-centric messaging.
Combined oral contraceptive pill remains first-line
For irregular periods and hyperandrogenism, the COCP is still recommended as initial therapy.
The guideline stresses choosing a pill based on individual risk, not automatically opting for low-androgenicity options.
Metformin has an expanded role
Metformin may be used for:
Metabolic benefits
Menstrual regulation
Women who cannot or prefer not to take hormonal therapy
It is first-line for glucose intolerance or insulin resistance.
New emphasis on mental health support
Screening for:
Anxiety
Depression
Eating disorders
Body image concerns
…is now considered essential, with appropriate referrals when needed.
Updated Fertility and Ovulation Induction Guidance
Letrozole remains first-line for ovulation induction
It is more effective than clomiphene citrate for:
Ovulation
Clinical pregnancy
Live birth rates
Clomiphene, metformin, and combination therapy remain options
The guideline provides clearer pathways depending on cycle patterns, metabolic profile, and previous treatments.
Gonadotrophins and IVF
These remain highly effective second-line options, with recommendations to reduce the risk of multiple pregnancy.
What This Means for Patients in New Zealand
The updated guideline offers:
More accurate diagnosis
More personal treatment plans
Better recognition of the emotional and metabolic aspects of PCOS
Safer, more effective fertility treatment pathways
It also reinforces the importance of holistic care, including lifestyle support, mental health screening, and long-term metabolic follow-up.
How I Support Patients With PCOS
In my practice, I offer:
Comprehensive PCOS assessment
Ultrasound and hormonal evaluation
Metabolic screening
Tailored management plans
Support for irregular cycles, acne, hirsutism, and pelvic pain
Fertility planning and ovulation induction
Telehealth appointments for patients across New Zealand
If you have concerns about PCOS or want to review your current management, you are welcome to book a consultation.
