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Saleh FL, Starkman H, Furness A, Pfeifer SM, Kives S. Polycystic Ovary Syndrome in Adolescents. Obstet Gynecol Clin North Am 2024; 51:679-693. [PMID: 39510738 DOI: 10.1016/j.ogc.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous endocrinologic disorder that is characterized by oligomenorrhea or amenorrhea and signs of hyperandrogenism. The cause of PCOS remains unknown, but the syndrome is associated with insulin resistance that in turn leads to hyperandrogenism. An accurate and prompt diagnosis of PCOS is important to understanding an adolescent's risk. In adolescents, both oligoovulation and hyperandrogenism are needed for the diagnosis of PCOS and ultrasound is not recommended. Lifelong health consequences of PCOS are significant and include obesity, diabetes, metabolic syndrome, and anovulatory infertility. The symptoms of PCOS can be disturbing to an adolescent girl.
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Affiliation(s)
- Farrah L Saleh
- Division of Reproductive Endocrinology and Infertility, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | | | | | - Samantha M Pfeifer
- Division of Reproductive Endocrinology and Infertility, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA
| | - Sari Kives
- Division of Pediatric Gynecology, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada.
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2
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Guan M, Li R, Wang B, He T, Luo L, Zhao J, Lei J. Healthcare professionals' perspectives on the challenges with managing polycystic ovary syndrome: A systematic review and meta-synthesis. PATIENT EDUCATION AND COUNSELING 2024; 123:108197. [PMID: 38377709 DOI: 10.1016/j.pec.2024.108197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/06/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To provide an overview of healthcare professionals' experience of PCOS management and identify the relevant facilitators and barriers. METHODS A systematic search was conducted in MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL database from the earliest available date to April 2023. Qualitative and mixed methods studies that described healthcare professionals' experiences of PCOS management were included. RESULTS A total of 74 findings were extracted from the 8 included studies, which were categorized into facilitators and barriers. The barriers were meta-aggregated into four themes: the weakness of clinical evidence; women's low adherence to PCOS management; various obstacles that healthcare professionals face, and the influence of social environment and culture. The facilitators were meta-aggregated into three themes: chronic disease healthcare plan, communication techniques and healthcare professionals' ability and awareness. CONCLUSION The findings of this study have the potential to improve the care provided to women with PCOS. However, it is important for national health professionals and policy markers to consider the cultural context of their own country when implementing these findings. PRACTICAL IMPLICATIONS This study illustrated several challenges in managing the heterogeneous condition of PCOS and provide insights for the development of medical policies and future research directions.
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Affiliation(s)
- Minhui Guan
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University,138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan,China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Rong Li
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University,138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan,China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Binglu Wang
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University,138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan,China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Tan He
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University,138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan,China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Lan Luo
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University,138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan,China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China
| | - Jinxin Zhao
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University,138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan,China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, Hunan, China.
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University,138 Tongzipo Road, Yuelu District, Changsha 410013, Hunan,China.
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3
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Benham JL, Goldberg A, Teede H, Tay CT. Polycystic ovary syndrome: associations with cardiovascular disease. Climacteric 2024; 27:47-52. [PMID: 38073517 DOI: 10.1080/13697137.2023.2282689] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/03/2023] [Indexed: 01/16/2024]
Abstract
Polycystic ovary syndrome (PCOS), characterized by abnormal menstrual periods, elevated androgen levels and polycystic ovary morphology on ultrasound, is the most common endocrine disorder among females. PCOS is associated with cardiovascular disease (CVD) risk factors including diabetes, obesity, metabolic syndrome, adverse pregnancy outcomes such as pre-eclampsia and psychosocial distress including depression. Previous evidence on the association between PCOS and CVD is inconclusive but the latest 2023 International Evidence-Based PCOS Guideline identifies PCOS as a risk factor for CVD. This review will discuss the relationship between PCOS and CVD along with current direction for CVD screening and prevention among individuals with PCOS.
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Affiliation(s)
- J L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Goldberg
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - H Teede
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - C T Tay
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Hanna F, Wu P, Heald A, Fryer A. Diabetes detection in women with gestational diabetes and polycystic ovarian syndrome. BMJ 2023; 382:e071675. [PMID: 37402524 DOI: 10.1136/bmj-2022-071675] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS) represent two of the highest risk factors for development of type 2 diabetes mellitus in young women. As these increasingly common conditions generally affect younger women, early detection of dysglycemia is key if preventative measures are to be effective. While international guidance recommends screening for type 2 diabetes, current screening strategies suffer from significant challenges.First, guidance lacks consensus in defining which tests to use and frequency of monitoring, thereby sending mixed messages to healthcare professionals.Second, conformity to guidance is poor, with only a minority of women having tests at the recommended frequency (where specified). Approaches to improve conformity have focused on healthcare related factors (largely technology driven reminder systems), but patient factors such as convenience and clear messaging around risk have been neglected.Third, and most critically, current screening strategies are too generic and rely on tests that become abnormal far too late in the trajectory towards dysglycemia to offer opportunities for effective preventative measures. Risk factors show wide interindividual variation, and insulin sensitivity and β cell function are often abnormal during pre-diabetes stage, well before frank diabetes.New, consistent, targeted screening strategies are required that incorporate early, prevention focused testing and personalised risk stratification.
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Affiliation(s)
- Fahmy Hanna
- Department of Diabetes and Endocrinology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
- Centre for Health and Development, Staffordshire University, Staffordshire UK
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Pensee Wu
- School of Medicine, Keele University, Keele, Staffordshire, UK
- Department of Obstetrics and Gynaecology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, Staffordshire, UK
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Adrian Heald
- Department of Diabetes and Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Anthony Fryer
- School of Medicine, Keele University, Keele, Staffordshire, UK
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5
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Copp T, Muscat DM, Hersch J, McCaffery KJ, Doust J, Dokras A, Mol BW, Jansen J. The challenges with managing polycystic ovary syndrome: A qualitative study of women's and clinicians' experiences. PATIENT EDUCATION AND COUNSELING 2022; 105:719-725. [PMID: 34099308 DOI: 10.1016/j.pec.2021.05.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore clinicians' and women's views and experiences with managing polycystic ovary syndrome (PCOS). METHODS Semi-structured interviews with 36 clinicians and 26 women with PCOS. Clinicians were recruited through advertising via relevant professional organisations, snowballing and contacting clinics across Australia. Women with PCOS were recruited through social media advertising. Transcribed audio-recordings were analysed thematically using Framework analysis. RESULTS Findings across women with PCOS and clinician interviews were organised into three themes. Both women and clinicians experienced 1) challenges with managing PCOS, often stemming from the disparate and wide spectrum of presentations, issues with current treatment options (including limited evidence) and the long-term nature of management. Both spoke about 2) online information about PCOS and alternative treatments, including lack of relevant information and widespread misinformation. 3) Follow-up and continuity of care, where we found notable differences between women's and clinicians' expectations. CONCLUSIONS This is the first study to explore both clinicians' and women's experiences with managing PCOS, illustrating several challenges in managing this heterogeneous condition. PRACTICE IMPLICATIONS Clarifying and addressing patient expectations, providing personalised counselling and information according to PCOS phenotype and a multidisciplinary approach may reduce uncertainty and improve patient-centred care.
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Affiliation(s)
- Tessa Copp
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 2006, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 2006, Australia.
| | - Danielle M Muscat
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 2006, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 2006, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 2006, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 2006, Australia
| | - Kirsten J McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 2006, Australia; Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, 2006, Australia
| | - Jenny Doust
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, 4006, Australia
| | - Anuja Dokras
- Penn PCOS Centre, Department of Obstetrics and Gynaecology, University of Pennsylvania, Philadelphia 19104, USA
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3800, Australia
| | - Jesse Jansen
- School of Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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6
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Lee ITL, Sansone S, Irfan M, Copp T, Beidas R, Dokras A. Implementation of International Guidelines for Polycystic Ovary Syndrome: Barriers and Facilitators Among Gynecologists and Primary Care Providers. F S Rep 2022; 3:94-101. [PMID: 35789712 PMCID: PMC9250120 DOI: 10.1016/j.xfre.2022.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/16/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To identify barriers and facilitators to the implementation of evidence-based guidelines among gynecologists and primary care physicians (PCPs) caring for women with polycystic ovary syndrome (PCOS). Design Qualitative semi-structured interview study. Setting Academic medical center. Patients None. Interventions None. Main Outcome Measures Barriers and facilitators in the diagnosis and management of PCOS. Results We interviewed 10 gynecologists and 8 PCPs to reach thematic saturation using a thematic analysis approach. Four themes were identified: diagnostic considerations, treatment of symptoms of PCOS, screening for long-term complications of PCOS, and counseling on long-term complications. Many gynecologists did not perform the recommended metabolic screening and were uncomfortable managing metabolic complications of PCOS. They uniformly counseled patients on the risk of endometrial hyperplasia and infertility. PCPs expressed the lack of familiarity with diagnostic criteria and often did not complete a comprehensive workup before making a diagnosis of PCOS. However, they routinely counseled patients on cardiometabolic risk and were familiar with managing the related long-term complications. Common barriers to comprehensive care delivery included the lack of knowledge and inadequate time and resources. Important facilitators included the overlap between the management of PCOS and other conditions such as obesity and abnormal uterine bleeding. Conclusions Our study highlights the need for interventions that target the barriers identified among gynecologists and PCPs in implementing guidelines for diagnosing and managing PCOS. In conjunction with prior studies, our findings support a multidisciplinary care model for women with PCOS. Future studies should focus on implementation strategies to facilitate evidence-based care.
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Affiliation(s)
- Iris Tien-Lynn Lee
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Reprint requests: Iris Tien-Lynn Lee, M.D., Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, Pennsylvania 19104.
| | - Stephanie Sansone
- Department of Urology, Weill Cornell Medicine, New York City, New York
| | - Maryam Irfan
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tessa Copp
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rinad Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Implementation Science Center (PISCE@LDI), Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Gojnic-Dugalic M, Stefanovic K, Stefanovic A, Jotic A, Lalic N, Petronijevic-Vrzic S, Petronijevic M, Milicic T, Lukic L, Todorovic J, Dugalic S, Pantic I, Nesic D, Stoiljkovic M, Stanisavljevic D, Perovic M. Distribution of normal and pathological OGTTs among pregnant population and non-pregnant women with PCOS - the cross-sectional study. Medicine (Baltimore) 2021; 100:e27232. [PMID: 34664864 PMCID: PMC8448046 DOI: 10.1097/md.0000000000027232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/28/2021] [Indexed: 01/07/2023] Open
Abstract
Both pregnancy, as physiological, and polycystic ovary syndrome (PCOS), as a pathological condition, carry the risk for developing glucose metabolism abnormalities. In this retrospective cross-sectional study, we hypothesized that pregnancy as a physiological condition carries a higher likelihood for abnormal oral glucose tolerance test (OGTT) results than PCOS as a pathological condition.We have compared the prevalence and likelihood ratios for abnormal OGTT results between non-pregnant women with PCOS (Group A) and pregnant women at 24 to 28 weeks of gestation (Group B). Participants of both study groups underwent glucose tolerance testing with 75 g glucose OGTT. During the study period, 7411 women were tested, 3932 women encompassed Group A, and 3479 women comprised Group B.The numbers of yearly tested pregnant women and the corresponding proportion of tested women among all study participants have decreased during the study period, from 766 to 131 and 89.1% to 20.5%, respectively. Group A had a significantly lower prevalence (4.4%) of pathological OGTT results compared to Group B (8.1%). This has resulted in a 45.427 likelihood ratio (P < .001) for abnormal OGTT results in pregnant women compared to non-pregnant women with PCOS.We might conclude that pregnancy could have a more challenging influence on glucose metabolism and that carries higher risks for abnormal glucose metabolism than PCOS. The awareness of obstetricians regarding physiological changes during pregnancy that predisposes abnormal glucose metabolism is decreasing over time and the compliance concerning OGTT testing of pregnant women is decreasing too.
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Affiliation(s)
- Miroslava Gojnic-Dugalic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Katarina Stefanovic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandar Stefanovic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra Jotic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Svetlana Petronijevic-Vrzic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Milos Petronijevic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Tanja Milicic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Ljiljana Lukic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Jovana Todorovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Serbia
| | - Stefan Dugalic
- Clinical Centre of Serbia, Clinic for Gynaecology and Obstetrics, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Igor Pantic
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Serbia
| | - Dejan Nesic
- Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Serbia
| | - Milica Stoiljkovic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinical Centre of Serbia, Clinic for Endocrinology, Diabetes and Metabolic Disease, Serbia
| | - Dejana Stanisavljevic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Milan Perovic
- Faculty of Medicine, University of Belgrade, Serbia
- Clinic for Gynaecology and Obstetrics “Narodni front,” Belgrade, Serbia
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Ma R, Zou Y, Wang W, Zheng Q, Feng Y, Dong H, Tan Z, Zeng X, Zhao Y, Deng Y, Wang Y, Sun A. Obesity management in polycystic ovary syndrome: disparity in knowledge between obstetrician-gynecologists and reproductive endocrinologists in China. BMC Endocr Disord 2021; 21:182. [PMID: 34488736 PMCID: PMC8422662 DOI: 10.1186/s12902-021-00848-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is associated with the development of polycystic ovary syndrome (PCOS) and contributes substantially to metabolic abnormalities in women with PCOS. The study aimed to describe and compare the practices of physicians in the diagnosis, evaluation, and treatment of obesity in patients with PCOS. METHODS Reproductive endocrinologists (Repro-Endo) and obstetrician-gynecologists (non-reproductive medicine specialty, OB-Gyn) in China participated in a survey, and their responses were analyzed using χ2 tests, Fisher exact tests, and multivariable logistic regression analysis. RESULTS The study analyzed 1318 survey responses (85.8% OB-Gyn; 97.3% women). Body mass index was the most common diagnostic criterion for obesity; only 1.3% of participants measured waist circumference to identify abdominal obesity. More Repro-Endo participants (25% of all participants) enquired about the psychological problems of patients with obesity than OB-Gyn participants, and 42.5% of participants reported ordering both a lipid profile and oral glucose tolerance test (OGTT) for patients with obesity and PCOS. Multivariable analysis, that included physician's specialty, age, hospital grade, and number of patients with PCOS seen annually, revealed that OB-Gyn participants were less likely to order OGTT (OR, 0.3; 95% CI, 0.2-0.4) and lipid profile (OR, 0.2; 95% CI, 0.1-0.3) than Repro-Endo participants. The most common treatments for patients with PCOS were lifestyle modification (> 95%) and metformin (> 80%). More Repro-Endo participants prescribed metformin at a dose of 1.5 g/day compared with OB-Gyn (47.6% vs. 26.3%), and more OB-Gyn participants reported being unclear about the appropriate dosage of metformin for patients with obesity and PCOS (8.9% vs. 1.6%). CONCLUSION Our survey identified knowledge gaps in metabolic screening for patients with obesity and PCOS and a disparity in the evaluation and treatment of obesity in PCOS among different specialties. Similarly, it highlights the need to improve obesity management education for physicians caring for women with PCOS.
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Affiliation(s)
- Ruilin Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ying Zou
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, Hunan, China
| | - Wei Wang
- Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China
| | - Qingmei Zheng
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, 266500, Shandong, China
| | - Ying Feng
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Han Dong
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Jinzhou, Jinzhou, 121000, Liaoning, China
| | - Zhangyun Tan
- Department of Obstetrics and Gynecology, Xinhui Maternity and Children's Hospital, Nanning, 529100, Guangxi, China
| | - Xiaoqin Zeng
- Department of Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, 510000, Guangdong, China
| | - Yinqing Zhao
- Department of Obstetrics and Gynecology, Xinhui Maternity and Children's Hospital, Nanning, 529100, Guangxi, China
| | - Yan Deng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yanfang Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Aijun Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100010, China.
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9
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Copp T, Muscat DM, Hersch J, McCaffery KJ, Doust J, Mol BW, Dokras A, Jansen J. Clinicians’ perspectives on diagnosing polycystic ovary syndrome in Australia: a qualitative study. Hum Reprod 2020; 35:660-668. [DOI: 10.1093/humrep/deaa005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/15/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract
STUDY QUESTION
What are clinicians’ views about the diagnosis of polycystic ovary syndrome (PCOS), and how do they handle any complexities and uncertainties in practice?
SUMMARY ANSWER
Clinicians have to navigate many areas of complexity and uncertainty regarding the diagnosis of PCOS, related to the diagnostic criteria, limitations in current evidence and misconceptions surrounding diagnosis, and expressed concern about the risk and consequences of both under- and overdiagnosis.
WHAT IS KNOWN ALREADY
PCOS is a complex, heterogeneous condition with many areas of uncertainty, raising concerns about both underdiagnosis and overdiagnosis. Quantitative studies with clinicians have found considerable variation in diagnostic criteria used and care provided, as well as a lack of awareness around the breadth of PCOS features and poor uptake of recommended screening for metabolic complications. Clinicians’ views about the uncertainties and complexities of diagnosing PCOS have not been explored.
STUDY DESIGN, SIZE, DURATION
Semi-structured telephone interviews were conducted with clinicians from September 2017 to July 2018 to explore their perceptions about the diagnosis of PCOS, including how they handle any complexities and uncertainties in practice.
PARTICIPANTS/MATERIALS, SETTING, METHODS
A group of 36 clinicians (15 general practitioners, 10 gynaecologists and 11 endocrinologists) currently practicing in Australia, were recruited through advertising via professional organisations, contacting a random sample of endocrine and gynaecology teams across Australia and snowballing. Transcribed audio-recordings were analysed thematically using Framework analysis.
MAIN RESULTS AND THE ROLE OF CHANCE
Clinicians expressed a range of uncertainties and complexities regarding the diagnosis of PCOS, which were organised into three areas: (i) establishing diagnosis (e.g. lack of standardisation regarding diagnostic cut-offs, risk of misdiagnosis), (ii) factors influencing the diagnostic process (e.g. awareness of limitations in evidence and consideration of the benefits and harms) and (iii) strategies for handling challenges and uncertainties (e.g. using caution and communication of uncertainties). Clinicians also varied in their concerns regarding under- and overdiagnosis. Overall, most felt the diagnosis was beneficial for women provided that it was the correct diagnosis and time was taken to assess patient expectations and dispel misconceptions, particularly concerning fertility.
LIMITATIONS, REASONS FOR CAUTION
There is possible selection bias, as clinicians who are more knowledgeable about PCOS may have been more likely to participate. Clinicians’ views may also differ in other countries.
WIDER IMPLICATIONS OF THE FINDINGS
These findings underscore the vital need to first consider PCOS a diagnosis of exclusion and use caution before giving a diagnosis in order to reduce misdiagnosis, as suggested by clinicians in our study. Until there is greater standardisation of diagnostic criteria, more transparent conversations with women may help them understand the uncertainties surrounding the criteria and limitations in the evidence. Additionally, clinicians emphasised the importance of education and reassurance to minimise the potential harmful impact of the diagnosis and improve patient-centred outcomes.
STUDY FUNDING/COMPETING INTEREST(S)
The study was funded by the University of Sydney Lifespan Research Network and an NHMRC Program Grant (APP1113532). T.C. is supported by an Australian Government Research Training Program (RTP) Scholarship and a Sydney Medical School Foundation Scholarship, from the The University of Sydney, Australia. B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA and Guerbet. No further competing interests exist.
TRIAL REGISTRATION NUMBER
N/A
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Affiliation(s)
- T Copp
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - D M Muscat
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - J Hersch
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - K J McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - J Doust
- Wiser Healthcare, Centre for Research in Evidence-Based Practice, Bond University, Robina, 4226, Australia
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, 3800, Australia
| | - A Dokras
- Penn PCOS Centre, Department of Obstetrics and Gynaecology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
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10
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Risks of Dysglycemia Over the First 4 Years After a Hypertensive Disorder of Pregnancy. Can J Diabetes 2019; 43:587-593. [PMID: 31585793 DOI: 10.1016/j.jcjd.2019.07.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/07/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Women with the hypertensive disorders of pregnancy (HDP) (preeclampsia [PE] and gestational hypertension [GHTN]) have increased risks of future diabetes. Postpartum glycemic testing offers early identification and treatment of dysglycemia, but evidence-based recommendations for this high-risk population are lacking. The objective of this study was to describe the risks of developing dysglycemia in women with normotensive and hypertensive pregnancies over the first 4 years postpartum. METHODS The Discharge Abstract Database was used to identify women who delivered singleton live-born infants in Calgary, Alberta, Canada, between January 2010 and December 2012 (N=27,300). This was linked with Calgary Laboratory Services (for glycemic tests) and the Pharmaceutical Information Network databases (for antidiabetes medication prescriptions) over the first 4 years postpartum. Logistic regression analyses compared glycemic testing and results were adjusted for maternal age, gestational age, parity and the Pampalon deprivation index. RESULTS Women with HDP had more glycemic testing (GHTN 67.8% and PE 69.9% vs normotensive 60.9%; p<0.001) and significantly higher results for fasting plasma glucose (GHTN 4.82±0.51 mmol/L and PE 4.84±0.54 mmol/L vs normotensive 4.73±0.49 mmol/L; p<0.001), random plasma glucose (GHTN 5.20±0.96 mmol/L and PE 5.39±1.71 mmol/L vs normotensive 5.00±0.87 mmol/L; p<0.001) and glycated hemoglobin levels (PE 5.62±0.53% vs normotensive 5.49±0.32%; p<0.001). Women with HDP had a higher adjusted odds (95% confidence interval) of developing type 2 diabetes compared with normotensive women (GHTN: 2.26, 1.50 to 13.4; PE: 2.02, 0.91 to 4.46). CONCLUSIONS The high prevalence of early dysglycemia highlights the importance of targeted postpartum glycemic testing in women after HDP. Further research on optimal glycemic testing (specific tests and timing) in these high-risk women is needed.
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Kazemi M, Pierson RA, Lujan ME, Chilibeck PD, McBreairty LE, Gordon JJ, Serrao SB, Zello GA, Chizen DR. Comprehensive Evaluation of Type 2 Diabetes and Cardiovascular Disease Risk Profiles in Reproductive-Age Women with Polycystic Ovary Syndrome: A Large Canadian Cohort. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1453-1460. [DOI: 10.1016/j.jogc.2018.11.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/23/2018] [Indexed: 12/16/2022]
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12
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Copp T, Jansen J, Doust J, Mol BW, Dokras A, McCaffery K. Are expanding disease definitions unnecessarily labelling women with polycystic ovary syndrome? BMJ 2017; 358:j3694. [PMID: 28814559 DOI: 10.1136/bmj.j3694] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Tessa Copp
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, NSW 2006, Australia
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), University of Sydney, NSW 2006, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, NSW 2006, Australia
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), University of Sydney, NSW 2006, Australia
| | - Jenny Doust
- Wiser Healthcare, Bond University, QLD 4229, Australia
- Centre for Research in Evidence-Based Practice, Bond University, QLD 4229, Australia
| | - Ben Wj Mol
- Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA 5005, Australia
- The South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Anuja Dokras
- Penn PCOS Centre, Department of Obstetrics and Gynaecology, University of Pennsylvania, Philadelphia, US
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, NSW 2006, Australia
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), University of Sydney, NSW 2006, Australia
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13
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Chan JL, Kar S, Vanky E, Morin-Papunen L, Piltonen T, Puurunen J, Tapanainen JS, Maciel GAR, Hayashida SAY, Soares JM, Baracat EC, Mellembakken JR, Dokras A. Racial and ethnic differences in the prevalence of metabolic syndrome and its components of metabolic syndrome in women with polycystic ovary syndrome: a regional cross-sectional study. Am J Obstet Gynecol 2017; 217:189.e1-189.e8. [PMID: 28400308 DOI: 10.1016/j.ajog.2017.04.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/16/2017] [Accepted: 04/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Polycystic ovary syndrome is a heterogeneous disorder and its presentation varies with race and ethnicity. Reproductive-age women with polycystic ovary syndrome are at increased risk of metabolic syndrome; however, it is not clear if prevalence of metabolic syndrome and clustering of its components differs based on race and ethnicity. Moreover, the majority of these women do not undergo routine screening for metabolic syndrome. OBJECTIVE We sought to compare the prevalence of metabolic syndrome and clustering of its components in women with polycystic ovary syndrome in the United States with women in India, Brazil, Finland, and Norway. STUDY DESIGN This is a cross-sectional study performed in 1089 women with polycystic ovary syndrome from 1999 through 2016 in 5 outpatient clinics in the United States, India, Brazil, Finland, and Norway. Polycystic ovary syndrome was defined by the Rotterdam criteria. Main outcome measures were: metabolic syndrome prevalence, blood pressure, body mass index, fasting high-density lipoprotein cholesterol, fasting triglycerides, and fasting glucose. Data from all sites were reevaluated for appropriate application of diagnostic criteria for polycystic ovary syndrome, identification of polycystic ovary syndrome phenotype, and complete metabolic workup. The US White women with polycystic ovary syndrome were used as the referent group. Logistic regression models were used to evaluate associations between race and metabolic syndrome prevalence and its components and to adjust for potential confounders, including age and body mass index. RESULTS The median age of the entire cohort was 28 years. Women from India had the highest mean Ferriman-Gallwey score for clinical hyperandrogenism (15.6 ± 6.5, P < .001). The age-adjusted odds ratio for metabolic syndrome was highest in US Black women at 4.52 (95% confidence interval, 2.46-8.35) compared with US White women. When adjusted for age and body mass index, the prevalence was similar in the 2 groups. Significantly more Black women met body mass index and blood pressure criteria (P < .001), and fewer met fasting triglycerides criteria (P < .05). The age- and body mass index-adjusted prevalence of metabolic syndrome was highest in Indian women (odds ratio, 6.53; 95% confidence interval, 3.47-12.30) with abnormalities in glucose and fasting high-density lipoprotein cholesterol criterion and in Norwegian women (odds ratio, 2.16; 95% confidence interval, 1.17-3.98) with abnormalities in blood pressure, glucose, and fasting high-density lipoprotein cholesterol criterion. The Brazilian and Finnish cohorts had similar prevalence of metabolic syndrome and its components compared to US White women. CONCLUSION Despite a unifying diagnosis of polycystic ovary syndrome, there are significant differences in the prevalence of metabolic syndrome and clustering of its components based on race and ethnicity, which may reflect contributions from both racial and environmental factors. Our findings indicate the prevalence of metabolic syndrome components varies in women with polycystic ovary syndrome, such that compared to White women from the United States, Black US women had the highest prevalence, whereas women from India and Norway had a higher prevalence of metabolic syndrome independent of obesity. The differences in clustering of components of metabolic syndrome based on ethnicity highlight the need to routinely perform complete metabolic screening to identify specific targets for cardiovascular risk reduction strategies in these reproductive-age women.
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Affiliation(s)
- Jessica L Chan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Eszter Vanky
- Department of Obstetrics and Gynecology, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway; Institute for Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland; PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland; PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Johanna Puurunen
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland; Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Jose Maria Soares
- Department of Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Edmund Chada Baracat
- Department of Gynecology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Anuja Dokras
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, PA.
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Dokras A, Saini S, Gibson-Helm M, Schulkin J, Cooney L, Teede H. Gaps in knowledge among physicians regarding diagnostic criteria and management of polycystic ovary syndrome. Fertil Steril 2017; 107:1380-1386.e1. [PMID: 28483503 DOI: 10.1016/j.fertnstert.2017.04.011] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To identify gaps in polycystic ovary syndrome (PCOS) knowledge and practice patterns among physicians in North America in response to significant dissatisfaction identified among women with PCOS regarding their diagnosis and treatment experience. DESIGN Online survey conducted via American College of Obstetrics and Gynecology of gynecologists (ObGyn) and American Society of Reproductive Medicine of reproductive endocrinologists (REI-ObGyn) in 2015-16. SETTING Not applicable. PATIENT(S) None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Diagnostic criteria used, key features of PCOS, management practices. RESULT(S) Of the 630 surveys completed, 70.2% were ObGyn and 64.4% were females. Overall 27.7% respondents did not know which PCOS diagnostic criteria they used. In a multivariable analysis including physician type, age, gender, and number of patients with PCOS seen annually, REI-ObGyn were less likely compared with ObGyn to report not knowing which criteria they used (adjusted odds ratio, 0.08; 95% confidence interval, 0.04, 0.16). REI-ObGyn were more likely to use the Rotterdam criteria (odds ratio, 2.26; 95% confidence interval, 1.33, 3.82). The majority of respondents recognized the clinical features associated with PCOS; however, over one-third associated "cysts on ovaries" with PCOS. The majority of responders (>85%) were aware of cardiometabolic comorbidities; however, fewer ObGyn were aware of associated depression, anxiety disorders, and reduced quality of life. More REI-ObGyn recommended lifestyle changes compared with ObGyn (56.4% vs. 41.6%). CONCLUSION(S) Our large-scale PCOS survey, conducted in response to patient concerns regarding diagnosis and treatment, highlights opportunities for physician education. Focus areas include targeting knowledge of internationally accepted Rotterdam criteria and ensuring consistent care informed by evidence-based guidelines across the reproductive, metabolic, and psychological features of PCOS.
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Affiliation(s)
- Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Shailly Saini
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jay Schulkin
- American College of Obstetrics and Gynecology, Department of Research, Washington D.C
| | - Laura Cooney
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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