A recent article by Australian authors, published in the BMJ, proposed that polycystic ovary syndrome (PCOS) is over diagnosed and spoke of the harms of ‘disease labelling’.
While the article has received media attention for its controversial nature, it has also been strongly disputed by leading PCOS researchers Dr Melanie Gibson-Helm, Professor Robert Norman and Professor Helena Teede, who state that PCOS is under-recognised and that delays in diagnosis cause harm.
Professor Rob Norman, a researcher with the University of Adelaide and Medical Director at Fertility SA said that the recent article in the BMJ drew on “limited evidence and did not engage affected women”.
“As both a researcher and a clinician who sees women struggling with fertility issues every week, it is clear that a timely diagnosis and an effective health care plan is always the best option for women with PCOS,” he said.
“In our extensive research studies we have found that PCOS is significantly under diagnosed, and that diagnosis of the disorder in adult women causes no additional distress. “Women often find that they have to see a number of health care professionals before they are diagnosed, and many feel a great sense of relief to have a diagnosis and then the ability to focus on managing their symptoms.”
The full article covering the background of PCOS diagnosis, prevalence, distress and next steps for research and treatment, can be found on the MJA Insight website.
For GPs looking for more information on PCOS diagnosis, here’s a checklist for what to look out for in patients.
PCOS checklist for GPs
What is PCOS
A hormonal disorder with multiple presentations including enlarged ovaries with small follicles on the outer edges. PCOS affects the reproductive, metabolic, endocrine and psychological aspects of health and occurs in about 12% of women.
The causes of PCOS
The cause of polycystic ovary syndrome isn’t well understood, but may involve a combination of genetic and environmental factors. It is unmasked by increase in weight.
Symptoms include menstrual irregularity, excess hair growth, acne, obesity and infertility. Diabetes mellitus is more common and insulin resistance occurs in more than 50%.
Treatments include birth control pills to regularise periods, medication called metformin to prevent diabetes, statins to control high cholesterol, ovulation induction drugs to increase fertility and procedures to remove excess hair. Lifestyle management is also a front-line strategy as the disorder worsens with weight gain and obesity.
PCOS and fertility
PCOS is known to have an impact on fertility. While some women with PCOS will be able to conceive naturally, some will require fertility assistance, including ovulation induction or IVF. GPs with patients with PCOS should refer them to a fertility clinic if there are irregular periods or after 12 months of unsuccessfully trying for a baby if the patient is under 35 and after 6 months for patients over 35.
Time to talk?
A number of the Fertility SA doctors are experts within the field of PCOS, and are available to speak to GPs and specialists who have any questions or need advice regarding the treatment or diagnosis of a patient. Good written information can be found here.