Polycystic Ovarian Syndrome: So Much More Than Infertility

^{By: Yvette C. Terrie, RPh, Consultant Pharmacist}

Polycystic ovarian syndrome (PCOS) is often associated with menstrual disorders such as oligomenorrhea, amenorrhea, menorrhagia, and infertility, and it is linked with an increased risk of endometrial hyperplasia and carcinoma. However greater awareness about PCOS is warranted since PCOS is a complex, lifelong, and often challenging disease which is the most common endocrine disorder affecting females of reproductive age. Left undiagnosed and untreated, PCOS can augment the risk of numerous comorbidities, including obstructive sleep apnea, metabolic syndrome, hypertension, dyslipidemia, cardiovascular disease, mental health issues such as anxiety and depression, glucose intolerance, and type 2 diabetes.

According to women surveyed and interviewed by the Warwick Medical School, treating PCOS as only a fertility condition is leaving those with the condition at higher risk of developing related long-term health conditions. The researchers found support and awareness lacking for other symptoms of PCOS to be very common. Moreover, results from the recent publication indicate that women with PCOS often feel that their primary healthcare providers underestimate the condition as only a fertility problem and do not discuss any of the other long-term health consequences. In the recent publication in the British Journal of General Practice, researchers attempted to understand the experiences of women with regard to how PCOS is diagnosed and managed.  The researchers utilized an online survey to obtain women’s experiences of general practice PCOS care. The survey was accessible online between January 2018 and November 2018. A subset of responders undertook a semi-structured telephone interview to provide more in-depth data.

Results from the survey revealed that a total of 323 women completed the survey (average age 35.4 years) and semi-structured interviews were conducted with 11 women.

• When surveyed, the researchers found that 83.1% of women felt they were given little information on the long-term complications by their health professional, and the information they were given was focused too much on the fertility implications of the condition.
• Participants described a variable lag time from presentation to PCOS diagnosis, with a median of 6–12 months.
• Many had experienced mental health problems associated with their PCOS symptoms but had not discussed these with their primary healthcare provider. The research revealed that 74.9% of women with PCOS had experienced mental health issues, but only 34.9% could recall this being discussed with their primary healthcare provider.
• Many were unable to recall any discussion about associated comorbidities with the healthcare provider.
• Only 19% of respondents could recall having had any such discussion on complications such as diabetes, and this was the most frequently discussed complication, with sleep apnea, non-alcoholic fatty liver disease, and endometrial hyperplasia getting even less attention.
• Some differences were identified between the experiences of women from Caucasian British backgrounds and those from other ethnic backgrounds. For example, Caucasian women were more likely to discuss their fertility with their providers.
• More than 80% of respondents said they felt their provider could have done more to help them better manage their symptoms.

The authors concluded that from the experiences of the women in this study, it appears that PCOS in general practice is not viewed as a long-term condition with an increased risk of comorbidities including mental health problems. Further research should explore healthcare providers’ awareness of comorbidities and the variances in PCOS care experienced by women from different ethnic backgrounds.

The lead author, Dr. Sarah Hillman from the Warwick Medical School noted that, “There needs to be greater awareness of the implications of the condition, both among the general public and health professionals. Education for health professionals should concentrate on reconsidering PCOS as a lifelong metabolic condition and not just one affecting fertility.”

In the US, the CDC reports that PCOS affects 6 to 12% representing more than 5 million women of reproductive age. The results of this survey clearly demonstrated that there is an urgent need to augment awareness among HCPs and patients about the plethora of health consequences associated with undiagnosed and untreated PCOS. Pharmacists are in a pivotal position to identify patients at risk and should encourage these patients to be screened for PCOS. Through patient education, expanding awareness, and continuing investigation into the complexities of this syndrome, the millions of women affected by PCOS can enhance their health and overall quality of life and possibly reduce or prevent the various associated comorbidities.

Yvette C. Terrie, R.Ph., Consultant Pharmacist and Medical Writer and creator of A Pharmacist’s Perspective (https://apharmacistsperspective.blogspot.com ).

References

1. Hillman, S.C., et al. (2020) Women’s experiences of diagnosis and management of polycystic ovary syndrome: a mixed-methods study in general practice. British Journal of General Practice. March 2020. doi.org/10.3399/bjgp20X708881.
2. Survey: Support for long-term health implications of PCOS is lacking. News. https://www.news-medical.net/news/20200312/Survey-Support-for-long-term-health-implications-of-PCOS-is-lacking.aspx.  Published March 12, 2020. Accessed April 9, 2020.