PCOS (Polycystic Ovary Syndrome) — A Clinicians View
- By Dr Emma Boulton
- ● 20 Nov 2015
PCOS, whilst not a disease, is a syndrome which often causes distress to women and can interfere with quality of life. Women with PCOS are more likely to have a range of chronic conditions such as obesity, insulin resistance, depression and infertility, all of which can impact on a woman’s health and wellbeing. There is good evidence to suggest that women with PCOS are more likely to be admitted to hospital and have a range of complicating conditions as a result of their PCOS (http://www.medicalnewstoday.com/articles/288518.php).
PCOS needs to be managed by a multi-disciplinary team. A good GP who is up on PCOS is the perfect candidate to help you deal with features and symptoms of PCOS, whether they are endocrine (hormones), weight related (find a good dietician), infertility (you may need a referral to a gynaecologist), a referral to a dermatologist (women with PCOS often have acne and hair distribution, which is as a result of excess male hormones). Because PCOS is a multifaceted condition, it is very easy for a GP to manage this problem with you. It is important that you focus on the issues that are impacting on your quality of life. Your primary concerns should be your doctor’s primary concerns and if your doctor hasn’t come across the Jean Hailes Foundation then you can point them to that resource (https://jeanhailes.org.au/contents/documents/Resources/Tools/PCOS_GP_tool.pdf).
Diagnosis of PCOS is a combination of using clinical features and tests. The most well-known diagnostic criteria is the Rotterdam Criteria 2003, where 2 out of the 3 following features have to be present: 1) Irregular or no periods, 2) Hirsutism, 3) Polycystic ovaries on ultrasound.
It is not uncommon for women to have polycystic ovaries on ultrasound and this doesn’t mean that they have PCOS. Blood tests which may be undertaken by your doctor include some hormone tests (SHBG, free androgen index, LH, FSH, estrodiol and progesterone, as well as blood sugar level). The treatment of PCOS depends really on the patient’s needs and concerns. For instance if acne and excessive hair is the issue then these features may be managed with a skin friendly contraceptive pill and laser treatment for facial hair. Issues relating to insulin resistance and cardiovascular disease risk are best managed by helping the patient lose weight. Weight loss in PCOS is no different from weight loss in other conditions or in obesity generally, in that you have to burn off more calories than you take in. However, because of the metabolic features of PCOS, it can be difficult for women to lose weight and it is recommended to recruit the assistance of a dietician or other Allied Health Professionals to help with motivation and provide support.
Treatment of infertility can be provided by gynaecologists with an interest in assisted reproductive technologies. However, reducing obesity and maintaining a healthy weight is the most important change you can make to assist with conception. Achieving a normal body weight will help a woman manage her pregnancy in the best way, with reduced risk of complications. Metformin is a medication which can be helpful for women with PCOS, it is often used as a diabetes medication but it can also help with aspects of infertility.
Women with PCOS are at slightly increased risk of endometrial cancer as a result of prolonged exposure to estrogen, without the benefits of regular ovulation. The risk of this can be reduced by using the combined oral contraceptive pill and losing weight. NHMRC Guidelines (https://www.nhmrc.gov.au/guidelines-publications/ext2) should be read by any clinician helping a patient manage their PCOS. The bottom line is that the patients immediate concerns should come first and that should help a doctor understand where to focus their efforts to help optimise function and have the best quality of life.
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