title: The effectiveness and safety of treatments used for polycystic ovarian syndrome management in adolescents: a systematic review and network meta-analysis protocol.
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
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  PROSPERO CRD42015016148.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada. reem_ah@yahoo.com.|Department of Pediatrics, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada. reem_ah@yahoo.com.|Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia. reem_ah@yahoo.com.
authors.forename: Reem A
authors.initials: RA
authors.lastname: Al Khalifah
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada. ivan.florez@udea.edu.co.|Department of Pediatrics, University of Antioquia, Medellín, Colombia. ivan.florez@udea.edu.co.
authors.forename: Iván D
authors.initials: ID
authors.lastname: Flórez
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada. dennisbb@mcmaster.ca.
authors.forename: Brittany
authors.initials: B
authors.lastname: Dennis
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada. binodn@gmail.com.
authors.forename: Binod
authors.initials: B
authors.lastname: Neupane
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Juravinski Site, G Wing, 2nd Floor, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada. thabanl@mcmaster.ca.|Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. thabanl@mcmaster.ca.|Department of Pediatrics and Anesthesia, McMaster University, Hamilton, Canada. thabanl@mcmaster.ca.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: Department of Pediatrics, Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada. bassile@mcmaster.ca.
authors.forename: Ereny
authors.initials: E
authors.lastname: Bassilious
mesh_terms: D000293:Adolescent; D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D003276:Contraceptives, Oral / Q000009:adverse effects / Q000627:therapeutic use*; D004032:Diet; D004359:Drug Therapy, Combination; D015444:Exercise; D005260:Female; D005485:Flutamide / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008019:Life Style; D008687:Metformin / Q000627:therapeutic use; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000077205:Pioglitazone; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000628:therapy; D012107:Research Design; D013148:Spironolactone / Q000627:therapeutic use; D000078202:Systematic Reviews as Topic; D045162:Thiazolidinediones / Q000627:therapeutic use; D055815:Young Adult; D015201:Meta-Analysis as Topic
chemical_list: D000726:Androgen Antagonists; D003276:Contraceptives, Oral; D007004:Hypoglycemic Agents; D000451:Mineralocorticoid Receptor Antagonists; D045162:Thiazolidinediones; D013148:Spironolactone; D005485:Flutamide; D008687:Metformin; D000077205:Pioglitazone