Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe

Prospective risk of Type 2 diabetes in 99 892 Nordic women with polycystic ovary syndrome and 446 055 controls: national cohort study from Denmark, Finland, and Sweden

STUDY QUESTION

What is the prospective risk of Type 2 diabetes (T2D) in Nordic women with polycystic ovary syndrome (PCOS) compared to controls?

SUMMARY ANSWER

A diagnosis of PCOS and BMI ≥30 kg/m2 is a high-risk phenotype for a prospective risk of T2D diagnosis across Nordic countries.

WHAT IS KNOWN ALREADY

The risk of T2D in women with PCOS is increased. The risk of T2D is related to BMI and the magnitude of risk in normal weight women with PCOS has been discussed. However, prospective data regarding risk of T2D in population-based cohorts of women with PCOS are limited.

STUDY DESIGN, SIZE, DURATION

This national register-based study included women with PCOS and age-matched controls. The main study outcome was T2D diagnosis occurring after PCOS diagnosis. T2D was defined according to ICD-10 diagnosis codes and/or filled medicine prescriptions of anti-diabetic medication excluding metformin.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The study cohort included women originating from Denmark (PCOS Denmark, N = 27 016; controls, N = 133 994), Finland (PCOS Finland, N = 20 467; controls, N = 58 051), and Sweden (PCOS Sweden, N = 52 409; controls, N = 254 010). The median age at cohort entry was 28 years in PCOS Denmark, Finland, and Sweden with a median follow-up time (interquartile range) in women with PCOS of 8.5 (4.0-14.8), 9.8 (5.1-15.1), and 6.0 (2.0-10.0) years, respectively. Cox regression analyses were adjusted for BMI and length of education.

MAIN RESULTS AND THE ROLE OF CHANCE

The crude hazard ratio (HR, 95% CI) for T2D diagnosis in women with PCOS was 4.28 (3.98-4.60) in Denmark, 3.40 (3.11-3.74) in Finland, and 5.68 (5.20-6.21) in Sweden. In adjusted regression analyses, BMI ≥30 vs <25 kg/m2 was associated with a 7.6- to 11.3-fold risk of T2D. In a combined meta-analysis (PCOS, N = 99 892; controls, N = 446 055), the crude HR for T2D in PCOS was 4.64 (3.40-5.87) and, after adjustment for BMI and education level, the HR was 2.92 (2.32-3.51).

LIMITATIONS, REASONS FOR CAUTION

Inclusion of more severe cases of PCOS in the present study design could have lead to an overestimation of risk estimates in our exposed population. However, some women in the control group would have undiagnosed PCOS, which would lead to an underestimation of T2D risk in women with PCOS. BMI data were not available for all participants. The present study should be repeated in study cohorts with higher background risks of T2D, particularly in populations of other ethnicities.

WIDER IMPLICATIONS OF THE FINDINGS

The prospective risk for diagnosis of T2D is increased in women with PCOS, and the risk is aggravated in women with BMI ≥30 kg/m2.

STUDY FUNDING/COMPETING INTEREST(S)

Funding in Denmark was from the Region of Southern Denmark, Overlægerådet, Odense University Hospital. Funding in Finland was from Novo Nordisk Foundation, Finnish Research Council and Sigrid Juselius Foundation, the National Regional Fund, Sakari Alhopuro Foundation and Finnish Diabetes Research Foundation. E.E. has received a research grant from Ferring Pharmaceuticals (payment to institution) and serves as medical advisor for Tilly AB, not related to this manuscript. The remaining authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies

Polycystic ovary syndrome (PCOS) is a multisystem disorder that presents with a variety of phenotypes involving metabolic, endocrine, reproductive, and psychological symptoms and signs. Women with PCOS are at increased risk of pregnancy complications including implantation failure, miscarriage, gestational diabetes, fetal growth restriction, preterm labor, and pre-eclampsia (PE). This may be attributed to the presence of specific susceptibility features associated with PCOS before and during pregnancy, such as chronic systemic inflammation, insulin resistance (IR), and hyperandrogenism, all of which have been associated with an increased risk of pregnancy complications. Many of the features of PCOS are reversible following lifestyle interventions such as diet and exercise, and pregnant women following a healthy lifestyle have been found to have a lower risk of complications, including PE. This narrative synthesis summarizes the evidence investigating the risk of PE and the role of nutritional factors in women with PCOS. The findings suggest that the beneficial aspects of lifestyle management of PCOS, as recommended in the evidence-based international guidelines, extend to improved pregnancy outcomes. Identifying high-risk women with PCOS will allow targeted interventions, early-pregnancy screening, and increased surveillance for PE. Women with PCOS should be included in risk assessment algorithms for PE.

International evidence-based guideline on assessment and management of PCOS-A Nordic perspective

Polycystic ovary syndrome (PCOS) affects about 12% of women of reproductive age. In 2018, the first evidence-based guideline on assessment and management of PCOS was published, and an updated extended guideline was released in August 2023. These guidelines followed best practice and are endorsed by 39 organizations worldwide, making them the most robust source of evidence to guide clinical practice. In the 2023 guideline, diagnostic criteria have been further refined as polycystic ovary morphology can now be assessed with gynecological ultrasound or elevated anti-Müllerian hormone levels. A healthy lifestyle should be at the focus of care for all women with PCOS; however, with no specific diet or physical exercise recommended. The latest evidence on medical treatments and fertility management are reviewed, including special considerations regarding long-term follow-up of metabolic and psychiatric comorbidities and pregnancy in women with PCOS. Here we summarize the recommendations from a Nordic perspective.

Assessment of health literacy in patients with polycystic ovary syndrome and its relationship with health behaviours: a cross-sectional study

OBJECTIVE

Healthy behaviours are important for people with polycystic ovary syndrome (PCOS). However, adopting and maintaining lifestyle changes involves a complex set of behavioural changes, which most patients fail to adhere to. The current research on health literacy, which includes individual and social skills needed in health self-management, in patients with PCOS is limited. Therefore, this study aimed to explore health literacy, health behaviours and the relationship between the two to expand research on PCOS management.

DESIGN

Cross-sectional study.

SETTING

A gynaecological outpatient clinic.

PARTICIPANTS

A total of 286 patients with PCOS (≥18 years, diagnosed via Rotterdam criteria, able to self-report and give informed consent) were recruited from March to June 2022.

OUTCOME MEASURES

Health literacy and health behaviours in patients with PCOS were assessed using the Health Literacy Management Scale and the Health Promoting Lifestyle Profile (Chinese version). Multiple logistic regression was used to analyse the factors influencing health literacy, and linear regression to assess the relationship between health literacy and health behaviours, with an F-significance test; p<0.05 was considered statistically significant.

RESULTS

Overall, most patients with PCOS had insufficient health literacy (55.9%). The influencing factors of health literacy in patients with PCOS were age (β=0.154, p<0.05), Body Mass Index (β=-0.140, p<0.05), income (β=1.228, p<0.05), duration of illness (β=0.110, p<0.05) and educational level (β=1.552, p<0.05). Moreover, 40.6% of patients with poor health behaviours, and 31.8% with moderate health behaviours, needed to improve their health behaviours. Health literacy was positively correlated with health behaviours in patients with PCOS (r=0.473, p<0.05).

CONCLUSION

The positive correlation between health literacy and health behaviour in patients with PCOS indicates that promoting health literacy in future treatment and management of PCOS may be beneficial.

Do Health Literacy and Awareness of Polycystic Ovary Syndrome Predict the Lifestyle Choices of Arabic-Speaking Female University Students

Background

Considering the increasing prevalence of Polycystic Ovarian Syndrome (PCOS) and its related complications-such as obesity, cardiovascular diseases, and infertility-in the Middle East, it is imperative to create sufficient public awareness about this issue. Accordingly, the potential link between PCOS awareness and health literacy level with the lifestyle choices of Arabic-speaking female university students was examined in this cross-sectional study.

Materials and Methods

This research was conducted in the Sultanate of Oman and involved 446 Arabic-speaking female university students, who completed a self-administered online questionnaire, Single Item Literacy Screener, and PCOS Awareness Tool.

Results

The findings showed that, while 53.50% of the study participants had inadequate health literacy, 79.80% demonstrated an acceptable level of PCOS awareness. However, this did not seem to influence their lifestyle, given that 59.20% of the respondents were physically inactive and 83.30% regularly consumed fast food. Regression analysis results nonetheless revealed that health literacy and PCOS awareness were significant predictors of lifestyle choices (F2,44 = 5.98, p < 0.05, 95% CI [4.44-5.35]).

Conclusions

The Arabic-speaking female university students' health literacy level and PCOS awareness are significant predictors of their lifestyle choices. Thus, the policymakers in the Arab region need to develop effective strategies aimed at PCOS prevention, focusing specifically on raising public awareness about PCOS and its negative consequences on female reproductive health. In addition, university administrators should ensure the availability of healthy food choices at their campuses as well as opportunities for physical activity to promote healthy lifestyle among all students.

Diabetes detection in women with gestational diabetes and polycystic ovarian syndrome

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.

Knowledge, attitude, and perceptions about polycystic ovarian syndrome, and its determinants among Pakistani undergraduate students

OBJECTIVE

The aim of the study was to evaluate knowledge, attitude, perception, and assess the determinants of polycystic ovarian syndrome (PCOS) among undergraduate students.

METHODS

A cross-sectional study was conducted among female undergraduate students in Pakistan using a survey. The questionnaire was formulated in English language by a review of literature and expert consensus. The sampling approach was convenient, and survey was available as electronic as well as hardcopy. Data were analyzed using IBM SPSS v23. Descriptive statistics namely mean ([Formula: see text]), standard deviation (SD), or median ([Formula: see text]) and interquartile range (IQR) were used dependent upon data distribution. In addition, range (R) was also utilized to express the results. The logistic and linear regression analyses were also conducted. Study received ethical clearance from ethics committees.

RESULTS

A total of 646 responses were analyzed. The average PCOS knowledge score was 11.58 ± 4.99 (overall), 12.02 ± 4.73 (medical students), 9.36 ± 5.65 (non-medical students) (α = 0.861). 68.6% participants did not feel embarrassed while discussing PCOS in the society, but 67.3% never discussed it with a doctor. Lack of self-knowledge (31.6%) and shyness/reluctance (21.4%) were identified as barriers by most students. Further, obesity, irregular menstrual periods, family history, hirsutism and contraceptive use were observed to be determinants for having PCOS (AOR > 2, p<0.05). The disease knowledge score was higher for participants studying in medical college (β = 0.184), having menstrual periods < 5 days (β = 0.125), and with a family history (β = 0.121) (p<0.05).

CONCLUSION

The disease knowledge among undergraduates was inadequate. However, there is greater acknowledgement of PCOS as a problem for Pakistani women and barriers have been identified in the study. Conducting awareness campaigns within academic institutions which include promoting disease education, arranging talks, distributing merchandise with disease awareness signage, would greatly help in raising awareness of the disease and lowering stigma and hesitancy.

Sex modifies the effect of genetic risk scores for polycystic ovary syndrome on metabolic phenotypes

Females with polycystic ovary syndrome (PCOS), the most common endocrine disorder in women, have an increased risk of developing cardiometabolic disorders such as insulin resistance, obesity, and type 2 diabetes (T2D). While only diagnosable in females, males with a family history of PCOS can also exhibit a poor cardiometabolic profile. Therefore, we aimed to elucidate the role of sex in the cardiometabolic comorbidities observed in PCOS by conducting bidirectional genetic risk score analyses in both sexes. We first conducted a phenome-wide association study (PheWAS) using PCOS polygenic risk scores (PCOSPRS) to identify potential pleiotropic effects of PCOSPRS across 1,380 medical conditions recorded in the Vanderbilt University Medical Center electronic health record (EHR) database, in females and males. After adjusting for age and genetic ancestry, we found that European (EUR)-ancestry males with higher PCOSPRS were significantly more likely to develop hypertensive diseases than females at the same level of genetic risk. We performed the same analysis in an African (AFR)-ancestry population, but observed no significant associations, likely due to poor trans-ancestry performance of the PRS. Based on observed significant associations in the EUR-ancestry population, we then tested whether the PRS for comorbid conditions (e.g., T2D, body mass index (BMI), hypertension, etc.) also increased the odds of a PCOS diagnosis. Only BMIPRS and T2DPRS were significantly associated with a PCOS diagnosis in EUR-ancestry females. We then further adjusted the T2DPRS for measured BMI and BMIresidual (regressed on the BMIPRS and enriched for the environmental contribution to BMI). Results demonstrated that genetically regulated BMI primarily accounted for the relationship between T2DPRS and PCOS. Overall, our findings show that the genetic architecture of PCOS has distinct sex differences in associations with genetically correlated cardiometabolic traits. It is possible that the cardiometabolic comorbidities observed in PCOS are primarily explained by their shared genetic risk factors, which can be further influenced by biological variables including sex and BMI.

Polycystic ovarian syndrome awareness among females in the UAE: a cross-sectional study

BACKGROUND

Polycystic Ovarian Syndrome (PCOS) is a common hormonal disorder affecting females of reproductive age. Clinical guidelines recommend following the diagnostic criteria of PCOS based on an appropriate assessment of the patient's clinical presentation. Sufficient awareness among the population will prompt females to seek medical attention when necessary. This study aimed to assess knowledge and awareness about PCOS among females above the age of 18 years in the United Arab Emirates (UAE) and to correlate the level of awareness with women's backgrounds, demographics, and education levels.

METHODS

This was a cross-sectional study conducted in early 2020. 430 females over the age of 18 years were conveniently selected and interviewed in the UAE using a 21-item questionnaire that assessed participants' awareness of PCOS as a term, its causes, symptoms, complications, treatment, and prevention. 414 entries were eligible for data analysis. IBM® SPSS® Statistics version 25 was used for data entry and analysis.

RESULTS

349 participants (84.3%) were familiar with the term PCOS. However, only 21.7% of them had sufficient awareness of the syndrome (95% CI = 17.77-25.71%). Being knowledgeable of PCOS was significantly associated with having a previous diagnosis (p = 0.002) and with studying or working in a medical field (p < 0.001). In addition, females who knew someone diagnosed with PCOS were 5 times more likely to be more aware compared to those who didn't (95% CI = 2.5-10.8; p < 0.001). Age, education level, and nationality showed no correlation with the level of awareness.

CONCLUSIONS

Overall, the level of PCOS awareness was insufficient in the study sample. Participants whose source of information was medical practitioners demonstrated more accurate knowledge. Accordingly, awareness of PCOS needs to be raised among females in the UAE, aiding early diagnosis and improving patient-oriented outcomes.

A structural equation model linking health literacy, self-efficacy, and quality of life in patients with polycystic ovary syndrome

BACKGROUND

Health literacy is a crucial factor that affects health outcomes. Understanding the current status of health literacy among patients with polycystic ovary syndrome (PCOS) is the basis for helping patients better manage risk factors and improve their health outcomes. This study aimed to explore the status of and factors influencing health literacy in patients with PCOS, and to validate the pathway between health literacy, quality of life, and self-efficacy for these patients.

METHODS

A cross-sectional study was conducted using a convenience sample of 300 patients with PCOS in the gynecology outpatient clinic of a tertiary hospital in Zunyi from March to September 2022. Data on health literacy, demographic features, quality of life, and self-efficacy were collected. Multiple stepwise linear regression was conducted to assess the risk factors associated with health literacy for the study participants. A structural equation model was used to construct and validate the pathways.

RESULTS

Most participants exhibited low health literacy (3.61 ± 0.72), and only 25.70% had adequate health literacy. Multiple regression analysis revealed that the main factors associated with health literacy among participants included Body Mass Index (BMI) (B = -0.95, p < 0.01), education (B = 3.44, p < 0.01), duration of PCOS (B = 4.66, p < 0.01), quality of life (B = 0.25, p < 0.01), and self-efficacy (B = 0.76, p < 0.01). Multiple fit values indicated that the model fit the data effectively. The direct effect of health literacy on self-efficacy and quality of life was 0.06 and 0.32, respectively. The indirect effect of health literacy on quality of life was -0.053, and the total effect of health literacy on quality of life was 0.265.

CONCLUSIONS

Health literacy was low among patients with PCOS. Healthcare providers should pay more attention to health literacy and to developing the corresponding intervention strategies urgently needed to improve the quality of life and health behavior of patients with PCOS.

Bridging the Information Gap in Polycystic Ovary Syndrome: A Narrative Review with Systematic Approach

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy with wide-ranging implications for affected individuals. Literature has shown that patients with PCOS are dissatisfied with the health information provided to them and that healthcare professionals lack adequate knowledge. In this narrative review with systematic approach, we explored the unmet information needs in PCOS care for both patients and healthcare professionals. A comprehensive search of databases yielded 41 relevant studies, predominantly of observational and qualitative design. Adults and adolescents with PCOS desire wide ranging health information and express a keen desire for weight management guidance. Importantly, discussions surrounding weight should be addressed knowledgeably and without weight bias. Therefore, healthcare professionals should facilitate access to comprehensive evidence-based resources. Lack of information drives PCOS-related online searches. Referral to support groups that promote individual agency in the self-management aspects of PCOS can furthermore guide patient resource acquisition. Patients prefer guidance from professionals that understand the psychosocial complexity of PCOS and can empathize with experiences of stigmatization or even marginalization depending on the cultural context of the individual. The findings informed the 2023 International Evidence-Based PCOS Guideline, recommending patient-centered communication, evidence-based information resources, and culturally sensitive approaches to optimize PCOS care.

Current Awareness Status of and Recommendations for Polycystic Ovarian Syndrome: A National Cross-Sectional Investigation of Central Jordan

Polycystic ovary syndrome (PCOS) is a common reproductive disorder that is related to a number of health issues and has an influence on a variety of metabolic processes. Despite its burden on the health of females, PCOS is significantly underdiagnosed, which is associated with lack of disease knowledge among females. Therefore, we aimed to gauge the awareness of PCOS in both the male and female population in Jordan. A descriptive cross-sectional study was conducted, targeting individuals over the age of 18 from Jordan's central region. Participants were recruited through stratified random sampling. The questionnaire consisted of two domains, including demographics and knowledge of PCOS domains. A total of 1532 respondents participated in this study. The findings revealed that participants have overall adequate knowledge regarding PCOS's risk factors, etiology, clinical presentation, and outcomes. However, participants demonstrated subpar familiarity of the association between PCOS and other comorbidities and the effect of genetics on PCOS. Women had more knowledge than men about PCOS (57.5 ± 6.06 vs. 54.1 ± 6.71, p = 0.019). In addition, older, employed, and higher-income populations showed significantly better knowledge than younger, unemployed, self-employed, and lower-income populations. In conclusion, we demonstrated that Jordanian women demonstrate an acceptable yet incomplete level of knowledge towards PCOS. We recommend establishing educational programs by specialists for the general population as well as medical personnel to spread accurate medical information and clarify common misconceptions about signs, symptoms, management, and treatment of PCOS, and nutritional knowledge.

Early diagnosis in polycystic ovary syndrome

ABSTRACT

NPs are in an ideal position to educate patients on the lifelong implications of polycystic ovary syndrome (PCOS). A timely diagnosis and comprehensive plan are needed to appropriately manage patients with PCOS. This article highlights diagnostic criteria, common comorbid conditions, psychological impacts of the clinical manifestations, management approaches, and implications for NPs.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) affects 5-18% of women, and is a reproductive, metabolic, and psychological condition with impacts across the lifespan. The cause is complex, and includes genetic and epigenetic susceptibility, hypothalamic and ovarian dysfunction, excess androgen exposure, insulin resistance, and adiposity-related mechanisms. Diagnosis is recommended based on the 2003 Rotterdam criteria and confirmed with two of three criteria: hyperandrogenism (clinical or biochemical), irregular cycles, and polycystic ovary morphology. In adolescents, both the criteria of hyperandrogenism and irregular cycles are needed, and ovarian morphology is not included due to poor specificity. The diagnostic criteria generates four phenotypes, and clinical features are heterogeneous, with manifestations typically arising in childhood and then evolving across adolescent and adult life. Treatment involves a combination of lifestyle alterations and medical management. Lifestyle optimisation includes a healthy balanced diet and regular exercise to prevent excess weight gain, limit PCOS complications and target weight reduction when needed. Medical management options include metformin to improve insulin resistance and metabolic features, combined oral contraceptive pill for menstrual cycle regulation and hyperandrogenism, and if needed, anti-androgens for refractory hyperandrogenism. In this Review, we provide an update on the pathophysiology, diagnosis, and clinical features of PCOS, and discuss the needs and priorities of those with PCOS, including lifestyle, and medical and infertility treatment. Further we discuss the status of international evidence-based guidelines (EBG) and translation, to support patient self management, healthcare provision, and to set research priorities.

Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion

Polycystic ovary syndrome (PCOS) is associated with a higher risk for pregnancy and birth complications according to the specific features associated with PCOS. The features include obesity before and during pregnancy, hyperandrogenism, insulin resistance, infertility, cardiometabolic risk factors, and poor mental health. PCOS is not often recognized as a risk factor for poor pregnancy and birth outcomes in pregnancy care guidelines, while its associated features are. Pregnancy-related risk profile should ideally be assessed for modifiable risk factors (e.g., lifestyle and weight management) at preconception in women with PCOS. Hyperglycaemia should be screened using a 75-g oral glucose tolerance test at preconception or within the first 20 weeks of pregnancy if it has not been performed at preconception and should be repeated at 24-28 weeks of pregnancy. In the absence of evidence of benefit for strategies specific to women with PCOS, the international evidence-based guidelines for the assessment and management of PCOS recommend screening, optimizing, and monitoring risk profile in women with PCOS (at preconception, during and postpregnancy) consistent with the recommendations for the general population. Recommended factors include blood glucose, weight, blood pressure, smoking, alcohol, diet, exercise, sleep and mental health, emotional, and sexual health among women with PCOS. The guidelines recommend Metformin in addition to lifestyle for assisting with weight management and improving cardiometabolic risk factors, particularly in those with overweight or obesity. Letrozole is considered the first-line pharmacological treatment for anovulatory infertility in PCOS. Individualized approach should be considered in the management of pregnancy in PCOS.

Women with polycystic ovary syndrome are burdened with multimorbidity and medication use independent of body mass index at late fertile age: A population-based cohort study

INTRODUCTION

This population-based follow-up study investigated the comorbidities, medication use, and healthcare services among women with polycystic ovary syndrome (PCOS) at age 46 years.

MATERIAL AND METHODS

The study population derived from the Northern Finland Birth Cohort 1966 and consisted of women reporting oligo/amenorrhea and hirsutism at age 31 years and/or a PCOS diagnosis by age 46 years (n = 246) and controls without PCOS symptoms or diagnosis (n = 1573), referred to as non-PCOS women. The main outcome measures were self-reported data on symptoms, diagnosed diseases, and medication and healthcare service use at the age of 46 years.

RESULTS

Overall morbidity risk was increased by 35% (risk ratio [RR] 1.35, 95% confidence interval [CI] 1.16-1.57) and medication use by 27% [RR 1.27, 95% CI 1.08-1.50) compared with non-PCOS women, and the risk remained after adjusting for body mass index. Diagnoses with increased prevalence in women with PCOS were migraine, hypertension, tendinitis, osteoarthritis, fractures, and endometriosis. PCOS was also associated with autoimmune diseases and recurrent upper respiratory tract infections and symptoms. Interestingly, healthcare service use did not differ between the study groups after adjusting for body mass index.

CONCLUSIONS

Women with PCOS are burdened with multimorbidity and higher medication use, independent of body mass index.

What can be done to improve polycystic ovary syndrome (PCOS) healthcare? Insights from semi-structured interviews with women in Canada

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common and perplexing condition affecting metabolic, reproductive, cardiovascular, and psychological health in women. Previous studies point to widespread dissatisfaction and frustration in women with the information and care they receive. Studies have found delays with the diagnosis of PCOS and gaps in knowledge in physicians regarding the diagnosis and management of PCOS. Little has been heard from women on what they think can be improved with PCOS care, especially in Canada. This qualitative study explores women's experiences navigating the healthcare system and their insights on what could be improved based on their lived experiences.

METHODS

Twenty-five participants were interviewed remotely over the phone by the first author between October and December 2018.Interviews were semi-structured and in-depth. Data were analyzed using thematic analysis and interpretive description methodology.

RESULTS

Twenty-five in-depth interviews conducted with participants across Canada (ages 18-63) revealed three overall areas in need of improvement. First, women emphasized a need for greater knowledge and awareness of PCOS in primary care physicians (PCPs) as well as the need for the medical community to prioritize women's health. Second, participants advocated for greater PCOS awareness and de-stigmatization in the general community and in women and girls, and any individuals with female reproductive systems. Third, participants brought up several needed resources, such as the need for more PCOS research to be funded and undertaken, more PCOS specialists and experts to be available, credible doctor-provided information (e.g., pamphlets, websites), and age-specific support groups and mental health supports to be available. Participants were generally unaware of existing PCOS organizations and brought up the need for established PCOS organizations to aid in the training and retraining of doctors and local awareness-building in communities.

CONCLUSIONS

Participants believed that PCPs in Canada needed to be well-versed on how to diagnose and manage PCOS to prevent delays in diagnosis and provide easier access to care. Further, greater awareness and de-stigmatization in the general community are needed so women can identify symptoms early and have access to support from those around them. Overall, PCOS may be an overlooked and under-prioritized condition, both in the Canadian healthcare system and general community.

A population-based follow-up study shows high psychosis risk in women with PCOS

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to 18% of women. Besides metabolic and fertility aspects, attention has lately been directed towards the detrimental effect of PCOS on psychological health. The objective of the study was to investigate whether women with PCOS are at higher risk for psychotic disorders. The study population derives from the Northern Finland Birth Cohort 1966 (N = 5889 women). The women with PCOS were identified by two simple questions on oligo-amenorrhea and hirsutism at age 31. Women reporting both symptoms were considered PCOS (N = 124) and asymptomatic women as controls (N = 2145). The diagnosis of psychosis was traced using multiple national registers up to the year 2016. Symptoms of psychopathology were identified using validated questionnaires at age 31. Women with PCOS showed an increased risk for any psychosis by age 50 (HR [95% CI] 2.99, [1.52-5.82]). Also, the risk for psychosis after age 31 was increased (HR 2.68 [1.21-5.92]). The results did not change after adjusting for parental history of psychosis, nor were they explained by body mass index or hyperandrogenism at adulthood. The scales of psychopathology differed between women with PCOS and non-PCOS controls showing more psychopathologies among the affected women. PCOS cases were found to be at a three-fold risk for psychosis, and they had increased psychopathological symptoms. PCOS should be taken into consideration when treating women in psychiatric care. More studies are required to further assess the relationship between PCOS and psychotic diseases.

Quality Improvement in the Evaluation and Diagnosis of Polycystic Ovary Syndrome in Adolescent Girls

STUDY OBJECTIVE

Polycystic ovary syndrome (PCOS) can be challenging to diagnose in adolescents because the diagnostic criteria for adult women overlap with normal features of pubertal development. Previous studies have highlighted inconsistencies in diagnostic criteria used by health care providers. International consensus groups have introduced recommendations to aid diagnosis of this disorder among adolescents. In this study we explored diagnostic inconsistencies and provided education for providers regarding these consensus recommendations.

DESIGN

Quality improvement.

SETTING

Teaching hospital-affiliated adolescent medicine clinic.

PARTICIPANTS

Adolescent medicine providers (n = 14) participated in the intervention.

INTERVENTIONS

Educational intervention on the basis of the 2015 international consensus recommendations was implemented to address provider inconsistencies.

MAIN OUTCOME MEASURES

Use of laboratory assessment and documentation for diagnosis of girls evaluated for possible PCOS.

RESULTS

Preintervention, providers used diverse diagnostic criteria including obesity, insulin resistance, mild acne, and minimal hirsutism with no reference to published criteria. Laboratory studies to exclude other disorders were obtained in 24/87 (28%) preintervention patients. Postintervention, the percentage of laboratory studies increased to 40/65 (62%). Oral glucose tolerance tests performed to assess for glycemic comorbidities increased from 6/87 (7%) to 16/65 (25%). After this intervention, providers included more documentation of features associated with PCOS yet did not use "at risk for PCOS" terminology.

CONCLUSION

After our educational intervention, providers showed greater awareness of diagnostic criteria for PCOS in adolescent girls. Medical record documentation and use of "at risk for PCOS" terminology needs improvement. Integration of specific PCOS templates in the electronic medical record might improve medical record documentation and appropriate diagnosis.

Natural History of Polycystic Ovary Syndrome and New Advances in the Epidemiology

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women, affecting up to 15% of the female population. The natural history of the syndrome is complex, including both androgen exposure in early life and adiposity-driven dysfunction involving also dysregulated, also involving altered hypothalamus-ovarian crosstalk. The manifestations can arise as early as childhood or puberty onward, suggesting that genetic susceptibility is an important etiological factor. In adulthood, women with PCOS present with reproductive, metabolic, and psychological health issues at a population-based level. Epidemiological studies on large datasets offer an excellent opportunity to evaluate health effects and costs related to the syndrome. Hospital or insurance-based datasets are also available; however, the results are not representative of the female population in the community. More longitudinal studies spanning from early childhood to late adulthood are needed to assess the long-term health impact and early manifestations of PCOS. Moreover, the identification of women with PCOS from large datasets can be expensive. Self-reported symptoms or PCOS diagnosis may offer a feasible approach.

Diagnosis delayed: health profile differences between women with undiagnosed polycystic ovary syndrome and those with a clinical diagnosis by age 35 years

STUDY QUESTION

Are reproductive, metabolic or psychological health profiles of women with clinically diagnosed polycystic ovary syndrome (PCOS) different from those with undiagnosed PCOS?

SUMMARY ANSWER

Obtaining a clinical diagnosis of PCOS is strongly linked to the experience of fertility problems, but not clinical depression or poor metabolic health, although these were highly prevalent in women with PCOS irrespective of when they were diagnosed.

WHAT IS KNOWN ALREADY

PCOS is an endocrine disorder that is relative common, but heterogeneous in presentation. This may impact on the pathways to diagnosis and timely treatment.

STUDY DESIGN, SIZE, DURATION

A cross-sectional analysis of a community-based cohort of 974 women, established retrospectively when women were around 30 years of age.

PARTICIPANTS/MATERIALS, SETTING, METHODS

In this cohort of women born in Adelaide, South Australia, half of women who met the Rotterdam criteria for PCOS were previously undiagnosed. We compared women with prior clinical diagnosis of PCOS, those diagnosed through participation in this research, and the remainder in the cohort. Sociodemographic characteristics, reproductive, metabolic and psychological health, including medical conditions and medications were considered. Logistic regression was undertaken to identify independent predictors of prior clinical diagnosis.

MAIN RESULTS AND THE ROLE OF CHANCE

There were 56 women with a prior clinical diagnosis of PCOS (5.7%) and a further 64 (6.6%) were undiagnosed until study entry. The great majority of women with a prior diagnosis of PCOS reported having had problems with periods (95%) and excess body hair (63%). Corresponding proportions for women undiagnosed until study participation were slightly lower (81% and 45%, respectively). Although the proportion of women attempting or achieving pregnancy was similar across all groups, those with a prior diagnosis of PCOS were four times more likely to have reported difficulties becoming pregnant than those undiagnosed (odds ratio = 4.05, 95% CI 1.74–9.45) and frequently sought medical assistance. Metabolic problems were higher in both PCOS groups compared to women without PCOS. In both PCOS groups, the prevalence of clinical depression was 50% higher than in those with no PCOS (P = 0.021).

LIMITATIONS, REASONS FOR CAUTION

The number of women who were diagnosed with PCOS both prior to and during the study limited statistical power available to detect modest differences between the PCOS groups. Some women in the group classified as not having PCOS may have remained undiagnosed, but any bias from this source would contribute to more conservative findings.

WIDER IMPLICATIONS OF THE FINDINGS

Findings reinforce the need for early detection of PCOS symptoms from adolescence, ensuring timely diagnosis and appropriate health care. The high prevalence of depression among clinically diagnosed and undiagnosed women with PCOS suggests this is a feature of the condition and supports recent recommendations in the international PCOS guidelines to screen all women with PCOS for depression and anxiety.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by a project grant (2017) from the National Health and Medical Research Council of Australia (NHMRC) Centre for Research Excellence in Polycystic Ovary Syndrome (Grant ID APP1078444). R.C.F. and J.C.A. were supported by Robinson Research Institute Lloyd Cox Career Development Fellowships (2018). Establishment of the cohort was funded by an NHMRC Strategic Award No. 465455, a Career Development Award in Population Health (No. 349548) and the Australian Research Council (Future Fellowship FT100101018) awarded to M.J.D. All authors declared no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

The effects of smoking on pregnancy risks in women with polycystic ovary syndrome: a population-based study

STUDY QUESTION

Is there is an association between smoking and pregnancy complications in pregnant women with polycystic ovarian syndrome (PCOS)?

SUMMARY ANSWER

There is an increased risk of developing gestational diabetes mellitus (GDM) among women with PCOS who smoke.

WHAT IS KNOWN ALREADY

Smokers are at increased risk of developing Type 2 Diabetes Mellitus (DM). Given the common pathophysiology and shared risk factors between type 2 DM and GDM, we sought to assess whether an association between smoking and the development of GDM exists.

STUDY DESIGN, SIZE, DURATION

This is a retrospective population-based study utilizing data from the HCUP-NIS over 11 years from 2004 to 2014. Pregnant women with PCOS who did smoke were compared to pregnant women with PCOS who did not smoke. A second comparison was made between pregnant smokers with and without PCOS. Of the 443 590 women who smoked during pregnancy and the 14 882 women with PCOS, 631 women were both smokers and diagnosed with PCOS.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) is the largest inpatient sample database in the USA and is composed of hospital inpatient stays submitted by hospitals throughout the entire country. Each year, the database provides information relating to 7 million inpatient stays, including patient characteristics, diagnosis and procedures. The data are representative of ∼20% of admissions to US hospitals across 48 states and the District of Columbia.

MAIN RESULTS AND THE ROLE OF CHANCE

There were no differences in the risks of preterm delivery (aOR1.2; CI 0.8-1.9), placental abruption (aOR1.1; CI 0.4-3.2), pregnancy induced hypertension (aOR1.0; CI 0.7-1.5), rate of operative vaginal delivery (aOR1.5; CI 0.9-2.5) and rates of cesarean section (C/S) (aOR1.0; CI 0.7-1.3) between smoking and non-smoking women with PCOS. A significant association between smoking and GDM was observed in women with PCOS (aOR1.5; CI1.01-2.1).

LIMITATIONS, REASONS FOR CAUTION

The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. Data regarding smoking and PCOS diagnosis could be skewed due to patients' underreporting, lack of documentation and documentation differences.

WIDER IMPLICATIONS OF THE FINDINGS

The public health implications of confirming smoking as a risk for GDM among women with PCOS are many. This can lead to earlier screening in pregnancy of smokers for GDM. Earlier initiation of interventions could decrease fetal complications and possibly have an impact on the life and long-term health of the offspring. Future studies are needed in order to assess whether smoking cessation during pregnancy decreases the risk of GDM in that gestation.

STUDY FUNDING/COMPETING INTEREST(S)

No external funding was used. The authors report no competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Is polycystic ovary syndrome appropriately diagnosed by obstetricians and gynaecologists across China: a nationwide survey

BACKGROUND

To describe the diagnostic criteria used and their application accuracy in the practice of polycystic ovary syndrome (PCOS) caring among obstetricians and gynaecologists across China.

METHODS

This was an Online cross-sectional survey of Obstetricians and gynecologists involved in PCOS caring conducted via the largest continuing education platform of obstetrics and gynecology across China from September 2019 to November 2019.

RESULTS

A total of 2,328 respondents were eligible for the final analysis. Of these, 94.5 % were general obstetricians and gynaecologists (Ge-ObGyn), and 5.5 % were reproductive endocrinologists (Re-ObGyn). Overall, the most frequently used criteria were the Androgen Excess and Polycystic Ovary Syndrome Society (AE-PCOS) criteria (48.2 %), followed by the Rotterdam criteria (35.7 %) and NIH criteria (12.1 %). Of the respondents, 31.3 % used their diagnostic criteria in their clinical practice. More respondents who chose the Rotterdam criteria could accurately apply the diagnostic criteria than those who chose the AE-PCOS criteria (41.2 % vs. 32.1 %, P < 0.001). Compared with Ge-ObGyn, Re-ObGyn were less likely to use the AE-PCOS criteria (adjusted odds ratio, 0.513; 95 % CI, 0.328-0.802; P < 0.05) and 1.492 times more likely to accurately use their criteria (95 % CI, 1.014-2.196; P < 0.05).

CONCLUSIONS

Less than one-third of obstetricians and gynaecologists across China could accurately use the diagnostic criteria they choose to diagnose PCOS. There is an urgent need to train obstetricians and gynaecologists on PCOS diagnosis in an effort to improve the medical care quality of patients with PCOS.

Evaluation of women knowledge and perception about polycystic ovary syndrome and its management in Jordan: A survey-based study

OBJECTIVES

Polycystic ovary syndrome (PCOS) is a common metabolic and endocrine disorder in females in their reproductive-age and is associated with clinical complications. The aim of this study was to evaluate the knowledge and perception of women in Jordan about PCOS, its symptoms, diagnosis and treatment.

METHODS

A descriptive, cross-sectional study that was designed in order to assess female knowledge, and perceptions about PCOS in Jordan. The study was carried out through a validated questionnaire and 227 was the number of recruited female participants.

RESULTS

The result showed that the participants had inadequate knowledge about PCOS. The major sources of information were physician and family (n = 77, 34%), 205 participants were aware that irregular or absence of menstrual cycle is a symptom of PCOS (90.3%). More than half of participants (55.9%) believe that PCOS patients have low body image. The educational level and marital status factors were significantly associated with participants' knowledge about PCOS (P-value = .008 and .004, respectively).

CONCLUSION

The result of this study concluded that women have insufficient knowledge about PCOS and its complication. There is a need to enhance the knowledge and perception in female population in Jordan by developing education using different sources.

Lifestyle management of polycystic ovary syndrome: a single-center study in Bosnia and Herzegovina

Background

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting up to 20% of pre-menopausal women. The most recent international guidelines set lifestyle management as the cornerstone of the PCOS treatment. Still, there is a paucity of data on the implementation of lifestyle management in clinical practice. This cross-sectional study aimed to explore physicians-reported practices in PCOS lifestyle management in the Sarajevo Canton, Bosnia and Herzegovina (BiH). The profession of dietetics is not legally recognized in BiH. Nutritional interventions in health promotion and disease treatment are provided by medical professionals.

Methods

Data were collected by a paper-based questionnaire distributed during March-May 2018 in the Public Institution Health Centre of Sarajevo Canton.

Results

Forty-six physicians (response rate of 80.7%) completed the questionnaire. An initial treatment plan based solely on lifestyle measures (diet + physical activity), as recommended by current guidelines was reported by 34.8% of physicians. Although dietary interventions were rated as highly relevant in PCOS management by the vast majority of physicians, only one-half reported recording patients' adherence and 45.7% of physicians were unsure of the effectiveness of the lifestyle interventions in their patients.

Conclusion

PCOS lifestyle management in the study setting is sub-optimal. Additional education on effective PCOS lifestyle management strategies would be beneficial, especially for physicians with less than 15 years in practice. Possible obstacles to better physicians' engagement in PCOS lifestyle management should be further investigated.

Current and experimental drug therapy for the treatment of polycystic ovarian syndrome

INTRODUCTION

Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects 8-13% of reproductive-age women. Irregular periods, hirsutism, or infertility are the most common clinical presentations of patients affected by PCOS. This syndrome is also linked to metabolic abnormalities such as type 2 diabetes, insulin resistance and obesity. The optimal therapeutic approach is still unknown.

AREAS COVERED

This narrative review offers an overview of the literature on current and experimental pharmacological options for treating PCOS and highlights ongoing clinical trials. Several electronic databases were searched and current research registers were analyzed to the present year. The papers selected for this review were critically analyzed, and all data available were summarized, organized, and explored to derive key information.

EXPERT OPINION

The main goal of PCOS treatment is to obtain a metabolic and hormonal balance. Optimal PCOS therapy should be direct to the reproductive abnormalities and the entire spectrum of endocrine and metabolic complications that appear to have a long-term negative impact on PCOS patient health, as in post-menopausal period. The discovery of new mechanisms in PCOS pathogenesis will offer the possibility of testing new drug classes.