Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.
Reference tool — not medical advice. Deterministic suggestions grounded in the 2023 International PCOS Guideline, to think with — not a prescriber. Clinician judgement, current product monographs, and live ODB coverage always required. Runs entirely in your browser — no data is collected.

Evidence: Health Canada / Teva Canada Limited 2026 · sources last checked 2026-09-23

PCOS treatment selector

Pick the main concern(s), age group, BMI, estrogen contraindications and treatment history — get ranked, reasoned treatment options across the cycles/hyperandrogenism, metabolic and fertility pathways, with the guideline reasoning and references behind each.

Main concern(s)

Age groupchoose one

BMIchoose one

Contraindications to estrogen

Selected items turn red to flag a contraindication; tap again to clear.

Treatment history

Notes

  • Screen everyone for depression and anxiety, and stay alert to disordered eating, especially around weight management.

Options

Select the main concern(s) to begin.

Key rules: trying to conceive routes to the fertility pathway (Letrozole first-line, Combined oral contraceptive pill (COCP), anti-androgens and GLP-1 medicines not offered); cycles or hyperandrogenism, not conceiving, routes to the Combined oral contraceptive pill (COCP) first-line unless an estrogen contraindication is present.

Related tools

Contraception selector · Acne · GLP-1 / weight management selector

Diagnosis & screening

2023 International PCOS Guideline — Rotterdam criteria as refined 2018/2023.

Adult criteria

  • Adults are diagnosed by the 2003 Rotterdam criteria as refined in 2018/2023: 2 of 3 of (1) ovulatory dysfunction/irregular cycles, (2) clinical or biochemical hyperandrogenism, and (3) polycystic ovarian morphology on ultrasound; serum AMH can now be used in adults as an alternative to ultrasound for the third criterion.[53]
  • When irregular cycles and hyperandrogenism are both already present, diagnosis is simplified and neither ultrasound nor AMH is required.[53]
  • AMH should only be used within the guideline's diagnostic algorithm as an alternative to ultrasound in adults, and is unnecessary when irregular cycles plus hyperandrogenism are already present; AMH should not be used as a single stand-alone diagnostic test.[54]

Adolescent criteria

  • Adolescents require BOTH ovulatory dysfunction and hyperandrogenism (not 2 of 3) — a stricter bar than adults — because normal pubertal physiology overlaps heavily with individual PCOS features.[55]
  • Ultrasound is not used in adolescents at all: there are no defined polycystic-ovarian-morphology thresholds validated for this age group, so it is not recommended.[55]
  • AMH is likewise not yet used in adolescents for PCOS diagnosis.[56]
  • Adolescents who have some PCOS features but don't meet full diagnostic criteria can be considered 'increased risk' and reassessed at or before full reproductive maturity, 8 years post-menarche — this 8-year mark is a reassessment timepoint for an at-risk label, not a threshold that unlocks ultrasound or AMH testing (those remain not recommended in adolescents generally).[55]

Exclude mimics before diagnosing

  • Before diagnosing PCOS, exclude other causes of the same picture: thyroid dysfunction (TSH), hyperprolactinaemia (prolactin), non-classic congenital adrenal hyperplasia (17-OH progesterone), and, where clinically indicated, other causes such as Cushing's syndrome or an androgen-secreting tumour; FSH is used to exclude hypogonadotropic hypogonadism as an alternative explanation for irregular cycles.[57]
  • If androgen levels are markedly above the reference range, or hyperandrogenism has new, severe or rapidly progressive onset, consider androgen-secreting ovarian/adrenal tumours, Cushing's syndrome, and severe insulin-resistance syndromes rather than PCOS — red flags, not routine screening triggers.[57]

Androgen testing

  • Total and free testosterone are the recommended first-line tests for biochemical hyperandrogenism; free testosterone can be estimated by the calculated free androgen index if direct free-testosterone assay isn't available.[58]
  • Labs should use LC-MS/MS (tandem mass spectrometry) for total/free testosterone rather than direct immunoassays, which have limited accuracy and poor sensitivity/precision for the low concentrations relevant in women.[59]
  • If testosterone/free testosterone is not elevated but hyperandrogenism is still suspected, androstenedione and DHEA-S can be considered, noting they are less specific and DHEA-S falls with age.[60]

Tests referenced above

Screening (at diagnosis, then ongoing)

Glycemic status[61]

75-g OGTT is the preferred test regardless of BMI; fasting glucose and/or HbA1c are acceptable fallbacks if OGTT isn't feasible, with reduced accuracy noted explicitly.

At diagnosis in all adults and adolescents, then reassessed every 1-3 years based on individual risk factors; an OGTT is also recommended when planning pregnancy or at the first prenatal visit if not done preconception, and again at 24-28 weeks gestation.

Lipids[62]

Full lipid profile: total cholesterol, LDL, HDL, triglycerides.

At diagnosis for all women with PCOS regardless of age or BMI; interval thereafter based on presence of dyslipidaemia and cardiovascular risk factors.

Blood pressure[63]

Blood pressure measurement.

Annually, and when planning pregnancy or seeking fertility treatment (higher risk of hypertensive disorders of pregnancy).

Obstructive sleep apnea[64]

Ask about OSA symptoms (snoring plus unrefreshing sleep, daytime sleepiness or fatigue); screen with a validated questionnaire (e.g. Berlin) if symptomatic, refer for a formal sleep study to diagnose.

If symptomatic; women with PCOS have a higher OSA prevalence independent of BMI, so a lower threshold to ask is reasonable.

Depression and anxiety[65]

Screen for depression (and, per the parallel anxiety recommendation, anxiety) using regionally validated screening tools.

In all adults and adolescents with PCOS — prevalence of moderate-to-severe depressive symptoms is high in this population.

Eating disorders / disordered eating[66]

Consider eating disorders and disordered eating regardless of weight, especially around weight-management and lifestyle discussions; refer for a full diagnostic interview if suspected.

Ongoing awareness, particularly whenever weight or lifestyle interventions are being discussed.

Endometrial cancer risk[67]

Awareness and counselling only — premenopausal women with PCOS have a markedly higher relative risk of endometrial hyperplasia/cancer, but absolute risk is low, so routine screening (e.g. surveillance ultrasound/biopsy) is explicitly NOT recommended. Additional risk factors are long-standing untreated amenorrhea, higher weight, type 2 diabetes and a persistently thickened endometrium; investigate (biopsy) only if excessive thickness is found.

Ongoing counselling from diagnosis onward; investigate only if a specific trigger (e.g. thickened endometrium, prolonged amenorrhea) is present.

Pregnancy risk[61]

PCOS carries higher risk of gestational diabetes and hypertensive disorders of pregnancy; OGTT is recommended when planning pregnancy or seeking fertility treatment (see glycemic status), and blood pressure should be checked at the same points.

Preconception counselling and throughout fertility treatment/pregnancy planning.

Guidelines

References

  1. [1]International PCOS Network (Monash University NHMRC Centre for Research Excellence in Women's Health in Reproductive Life, in partnership with ASRM, Endocrine Society, ESE, ESHRE) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  2. [2]The Society of Obstetricians and Gynaecologists of Canada (SOGC) (2025). SOGC Position Statement: Inositol for the Management of Polycystic Ovary Syndrome. link
  3. [3]The Society of Obstetricians and Gynaecologists of Canada (SOGC), Reproductive Endocrinology and Infertility Committee (2018). No. 362-Ovulation Induction in Polycystic Ovary Syndrome. link
  4. [4]American College of Obstetricians and Gynecologists (ACOG) (2018). ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. link
  5. [5]Endocrine Society (2013). Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline. link
  6. [6]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  7. [7]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  8. [8]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  9. [9]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  10. [10]Health Canada / Novartis Pharmaceuticals Canada Inc. (2022). FEMARA (letrozole) Product Monograph. link
  11. [11]Health Canada / sanofi-aventis Canada Inc. (2013). CLOMID (clomiphene citrate) Product Monograph. link
  12. [12]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  13. [13]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  14. [14]Health Canada / Pfizer Canada ULC (2024). ALESSE 21 / ALESSE 28 (levonorgestrel / ethinyl estradiol) Product Monograph. link
  15. [15]Health Canada / Pfizer Canada ULC (2024). ALESSE 21 / ALESSE 28 (levonorgestrel / ethinyl estradiol) Product Monograph. link
  16. [16]Health Canada / Pfizer Canada ULC (2024). ALESSE 21 / ALESSE 28 (levonorgestrel / ethinyl estradiol) Product Monograph. link
  17. [17]Health Canada / Pfizer Canada ULC (2024). ALESSE 21 / ALESSE 28 (levonorgestrel / ethinyl estradiol) Product Monograph. link
  18. [18]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  19. [19]Monash Centre for Health Research and Implementation (for the International PCOS Guideline) (2023). Efficacy and safety of anti-androgens in the management of polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials. link
  20. [20]Health Canada / Bayer Inc. (2017). DIANE-35 Product Monograph. link
  21. [21]Health Canada / Bayer Inc. (2017). DIANE-35 Product Monograph. link
  22. [22]Health Canada / Bayer Inc. (2017). DIANE-35 Product Monograph. link
  23. [23]Ontario Ministry of Health (2026). Ontario Drug Benefit Formulary/Comparative Drug Index -- search result for "cyproterone". link
  24. [24]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  25. [25]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  26. [26]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  27. [27]Health Canada / Novo Nordisk Canada Inc. (2025). WEGOVY (semaglutide injection) Product Monograph. link
  28. [28]Health Canada / Novo Nordisk Canada Inc. (2025). SAXENDA (liraglutide injection) Product Monograph. link
  29. [29]Ontario Ministry of Health (2026). Ontario Drug Benefit Formulary/Comparative Drug Index -- search result for "semaglutide" (Wegovy entry). link
  30. [30]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  31. [31]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  32. [32]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  33. [33]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  34. [34]Monash Centre for Health Research and Implementation (for the International PCOS Guideline) (2023). Efficacy and safety of anti-androgens in the management of polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials. link
  35. [35]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  36. [36]Society of Obstetricians and Gynaecologists of Canada (SOGC) (2017). No. 329-Canadian Contraception Consensus Part 4 of 4 Chapter 9: Combined Hormonal Contraception. link
  37. [37]Ontario Ministry of Health (2026). Ontario Drug Benefit Formulary/Comparative Drug Index -- search result for "levonorgestrel". link
  38. [38]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  39. [39]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  40. [40]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  41. [41]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  42. [42]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  43. [43]Health Canada / Teva Canada Limited (2013). TEVA-METFORMIN (metformin hydrochloride) Product Monograph. link
  44. [44]Ontario Ministry of Health (2026). Ontario Drug Benefit Formulary/Comparative Drug Index -- search result for "metformin". link
  45. [45]Health Canada / Teva Canada Limited (2026). TEVA-SPIRONOLACTONE (spironolactone) Product Monograph. link
  46. [46]Ontario Ministry of Health (2026). Ontario Drug Benefit Formulary/Comparative Drug Index -- search result for "spironolactone". link
  47. [47]Health Canada - Drug Product Database (2026). DIANE-35 (cyproterone acetate / ethinyl estradiol) - Drug Product Database listing. link
  48. [48]Health Canada / Cipher Pharmaceuticals Inc. (2015). VANIQA (eflornithine hydrochloride) Cream Product Monograph. link
  49. [49]Ontario Ministry of Health (2026). Ontario Drug Benefit Formulary/Comparative Drug Index -- search result for "semaglutide". link
  50. [50]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  51. [51]International PCOS Network (Monash University / NHMRC) (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  52. [52]Ontario Ministry of Health (2026). Ontario Drug Benefit Formulary/Comparative Drug Index -- search result for "letrozole". link
  53. [53]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  54. [54]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  55. [55]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  56. [56]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  57. [57]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  58. [58]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  59. [59]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  60. [60]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  61. [61]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  62. [62]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  63. [63]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  64. [64]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  65. [65]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  66. [66]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link
  67. [67]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link