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Table 1 Potential COVID-19-related implications on aspects of polycystic ovary syndrome (PCOS) management (in women with PCOS who are diagnosed with COVID-19, a relevant risk assessment should be performed by the treating physician and any existing treatment should be promptly re-evaluated and optimized, as clinically indicated)

From: Polycystic ovary syndrome (PCOS) and COVID-19: an overlooked female patient population at potentially higher risk during the COVID-19 pandemic

A) For women with PCOS on off-label metformin treatment: it is advisable to consider discontinuing metformin when diagnosed with COVID-19, particularly when symptoms of severe COVID-19 are present and if they become unstable, as also recommended for patients with diabetes
B) For women with PCOS and diabetes:
 - Should consider discontinuing sodium-glucose co-transporter-2 inhibitors (SGLT2i) when COVID-19 is diagnosed, particularly when symptoms of severe COVID-19 are present
 - Should continue and optimize insulin therapy, as clinically indicated
 - Can continue the use of dipeptidyl peptidase-4 (DPP4) inhibitors where clinically indicated (the dose of certain DPP4 inhibitors may need adjustment if renal function is affected in severe COVID-19)
 - Should consider avoiding/optimizing the use of sulfonylureas when COVID-19 is diagnosed, particularly when symptoms of severe COVID-19 are present, due to the risk of hypoglycemia
C) Women with PCOS and known or suspected insulin resistance (known type 2 diabetes or prediabetes) who receive glucocorticoid treatment for COVID-19 may exhibit overt glucocorticoid-induced glucose/metabolic dysregulation
D) Women with PCOS and hypertension may continue treatment with common antihypertensive drugs [angiotensin converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), thiazide diuretics, calcium-channel blockers and beta-blockers], as indicated, since available data so far indicate that these appear to not substantially increase the risk for testing COVID-19 positive and for severe COVID-19
E) Women with PCOS and obstructive sleep apnea (OSA) may continue home use of continuous positive airway pressure (CPAP) therapy, but, particularly in cases of home self-isolation due suspected or confirmed COVID-19, these patients should consider either taking strict quarantine measures from other household members (e.g., use of separate bedrooms and bathrooms where feasible) or discontinuing CPAP therapy for a short period, due to potential risk of SARS-CoV-2 aerosolized transmission from the CPAP use. During any such temporary CPAP therapy discontinuation, sedating medications and alcohol should be avoided, while other measures to reduce OSA can also be considered, such as positional therapy during sleep, nasal congestion treatment, and dental appliance use where possible