How can GPs help women manage polycystic ovary syndrome?

Carolyn Ee

26/02/2019 3:47:48 PM

GP Dr Carolyn Ee writes about what is a common but often under-recognised condition.

Polycystic ovary syndrome presents a long-term challenge for patients and GPs.
Polycystic ovary syndrome presents a long-term challenge for patients and GPs.

Polycystic ovary syndrome (PCOS) is a common women’s health condition – roughly one in 10 women experience it.
It is a lifelong condition that can present significant physical and emotional challenges.
The hyperandrogenemia that is characteristic of the syndrome means women with PCOS may have excessive hair growth. This, perhaps not surprisingly, can challenge their identity as a woman.
My colleagues and I have written a paper, currently under review by BMC Women's Health, that explores the experience of living with PCOS. We have identified some ways in which GPs can help women manage the condition over the long term.
After interviewing 10 women with PCOS, we found many were experiencing significant anxiety about the future, dissatisfaction with current treatment, and a loss of feminine identity. Weight management was a key concern for these women.
One of our interviewees told us: ‘All that packaging that comes with PCOS – hormone imbalance [and] facial hair and all that other stuff  … whatever is happening inside your body because you know something’s not right there – so the whole package deal I guess.’ She also said that PCOS made her feel as if she was ‘turning into a man’.
Primary care
GPs provide comprehensive whole-person care, so we’re ideally placed to treat PCOS.
It is not just a reproductive issue, though women might initially present with concerns over missing or irregular periods. PCOS can also affect psychological health, and may lead to anxiety and depressive symptoms and distress regarding body image.
Women with this condition report a lower quality of life due to these issues. However, it is important to say that although women with PCOS may take a little longer to fall pregnant, research suggests they have the same family size as women without PCOS.
Later in life, there are increased risks of diabetes and potentially heart disease. Eating disorders are also more common.
That means we, as GPs, have a key part to play – from the time an adolescent comes in with irregular periods to a full diagnosis as an adult, from fertility issues or someone expressing concern around their binge eating, all the way through to screening for cardiovascular health and managing mental health.
Monash University researchers released updated international guidelines last year, and several of my co-authors were involved.
The guidelines will help GPs better manage this condition, including by asking simple screening questions related to anxiety and depression. They also include some great resources that have been developed specifically for GPs, such as a one-page diagnostic algorithm, along with co-designed consumer resources.

Carolyn-Ee_260219-Article.jpgDr Ee and her research colleagues have found that women with PCOS may not have been receiving the best supports in the past.
Effective medical treatments for PCOS are sadly limited, which is another frustration our study picked up, and there is still no cure.
One of our interviewees said: ‘This is not a very rare condition or anything. You would see every other woman nowadays have PCOS. It just feels bad and something that we’re missing that we do not have a cure for this. Still now in 2017 and we don’t have a cure for this; it’s like something so rare.’
While there is no cure, we have learned a lot about PCOS over the last 10 years or so. There is progress.
What can help is a healthier weight, as even a 5% weight loss makes genuinely beneficial impacts on the rest of their health. So improving lifestyle and exercise can lead to improvements across the board. There is a great new app, AskPCOS, designed for patients.
So many aspects of health
PCOS is most definitely a complex condition, and one that some GPs may find tricky to diagnose, particularly as there are different aspects that manifest at different times.
What I found striking in speaking with our interviewees was the fact this condition affects so many aspects of their health.
It wasn’t just the challenge to their fertility, but the sense that something wasn’t right with their bodies. PCOS will often cause women to be overweight or to have visible signs of hyperandrogenemia, which can be distressing. We spoke to women in their 40s who worried about diabetes and heart disease.
We don’t know exactly why losing weight benefits these women. It might improve insulin resistance and chronic inflammation. Our interviewees all knew about the importance of weight loss. A somewhat cruel aspect of the condition, however, is that it is actually makes it harder for a person to lose weight.
Our interviewees struggled with this. Jessica* told us about ‘a lifetime of yo-yo dieting’, while others talked about putting the weight back on every time it came off.
Our interviewees felt as though they were already up against a wall when they started any new lifestyle modification – that other people lost weight relatively easily while they struggled even if they were doing everything they were told by doctors and allied health professionals.
Many interviewees reported feeling isolated, and most didn’t know about the existence of support groups like the Polycystic Ovary Syndrome Association of Australia.
One key thing we’ve learned from our research is that these women may not have been getting quite the best supports in the past. We know a great deal now about behaviour change strategies, but our interviewees told us they has historically not been well supported in the journey, or taught how to set and reach goals, or overcome a lack of intrinsic motivation.
All of them described exercise as unenjoyable and difficult. It was a chore. And the fact many of these women also have increased anxiety and depression proved another barrier to exercise.
Something these women really wanted was their GP to act as their health coaches to help with lifestyle modification. They want us to be supportive – but also a bit pushy. I think we can do that.
*Not her real name.

PCOS polycystic ovary syndrome women’s health

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