Piecing together the puzzle of polycystic ovary syndrome

Irregular menstrual cycles, hirsutism, acne, difficulty managing weight.
 
These are some of the symptoms of polycystic ovary syndrome (PCOS), a condition that is regularly misdiagnosed but can have major health implications for women, including infertility and type 2 diabetes.
 
Such a broad range of symptoms means PCOS can easily be overlooked by GPs; but it is the GP that plays the most important role in diagnosing and managing the condition, according to Professor Helena Teede, Director Monash Centre for Health Research and Implementation, Monash University.
 
‘GPs are absolutely vital in this condition,’ Professor Teede told newsGP. ‘They are going to be the one to make the diagnosis and the one to coordinate the lifelong care.’
 
Professor Teede led the development of the newly released International evidence-based guideline for the assessment and management of polycystic ovary syndrome, an international collaboration between health professionals and patients that is designed to assist clinical diagnoses and support patient care.
 
Based on her research for the guidelines with women who have PCOS, Professor Teede found that these women have very strong opinions about wanting to know what they have – getting a firm diagnoses to support their symptoms.
 
‘They want to know early so they can understand the bits of the puzzle and know that something is not right,’ Professor Teede said.
 
‘It was important for [the women in the study] to have the diagnosis, because it empowered them to make changes and be motivated to be a lot healthier, and understand that it may impact their reproductive potential.’
 
The new guidelines, with accompanying patient resources and GP tools, including care plans, were implemented with the help of GPs who, according to Professor Teede, were instrumental in the process of developing the guidelines. These GPs highlighted the fact that they need more information about PCOS in primary care.
 
‘The GPs’ message [from the study] was, “We’re not thinking about PCOS as a multidisciplinary, complex condition that needs care plans, and we don’t have access to the right, simple information on how to manage it and the support material for consumers”,’ she said.
 
Professor Teede believes that, from the patients’ perspective, women want to partner with and receive ongoing support from their GPs.
 
‘They’re not wanting specialist referral, they want primary care,’ she said.
 
‘GPs are most likely to be the first person to see the woman and to diagnose PCOS, so it’s really important they recognise and diagnose it.
 
‘There might be times when the patient sees a dermatologist, a reproductive specialist, an endocrinologist, but the ultimate lifelong plan sits with the GP and that’s what women want.’
 
Recognising the signs, diagnosis, and establishing a long-term care plan with patients can help prevent the impacts of PCOS, which can be underestimated, according to Professor Teede.
 
‘The psychological impact [of PCOS] is often quite profound,’ she said. ‘It has major quality of life, anxiety and depression impacts, and that’s what often is not appreciated.’
 
Professor Teede cites irregular menstrual cycles as one of the most important things of which to be aware, as well as features of high androgen levels, such as hirsutism and acne, which can also have a psychological impact on women.
 
She recommends acting early on these signs, before potential issues arise later in life.
 
‘If women [who have symptoms of PCOS] go on the pill during adolescence and then come off in their early 30s, they won’t have early family planning initiation, they won’t learn to focus on prevention of weight gain and the importance of a healthy lifestyle, they won’t have had their anxiety or psychological issues, or even their hirsutism well-managed,’ she said.
 
‘And by the time they come off the pill, they’re often carrying quite a lot of weight, may have trouble getting pregnant, are insulin resistant, and often have pre-diabetes.
 
‘They haven’t had the chance of treatment of their issues.’
 
Irregular cycles, excess androgens, blood tests or clinical features are the key diagnostic criteria in women to use when diagnosing PCOS, Professor Teede said. However, she advises that ultrasound is not always necessary.
 
‘Only do an ultrasound if you have one of the symptoms, so women will not be having expensive, uncomfortable and unnecessary ultrasound,’ she said.
 
‘In adolescence or in women within eight years of starting their cycle, there is no role for ultrasound, because it’s pretty much always positive. So that’s where we get the false diagnoses.
 
Professor Teede believes the partnership between patients and their GP can help break the barrier of under-recognising and misdiagnosing PCOS, and the potential issues it can cause.
 
‘There is enough information now available for women to be able to manage this condition with their GP for the majority of cases,’ she said.
 
Further GP resources

• The RACGP’s General practice management of type 2 diabetes 2016–18 includes a chapter on the link between PCOS and type 2 diabetes, and presents diagnostic criteria and basic management plans.
   
• The Australian Journal of General Practice (AJGP) published a recent article, Polycystic ovary syndrome in Central Australia: Diagnosis and screening of cardiometabolic risk and emotional wellbeing, focusing on management of PCOS in Aboriginal and Torres Strait Islander primary care settings.

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