Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe

Abstract

ObjectiveTo date, little is known about differences in the knowledge, diagnosis making and treatment strategies of health care providers regarding polycystic ovary syndrome (PCOS) across different disciplines in countries with similar health care systems. To inform guideline translation, we aimed to study physician reported awareness, diagnosis and management of PCOS and to explore differences between medical disciplines in the Nordic countries and Estonia.MethodsThis cross-sectional survey was conducted among 382 endocrinologists and obstetrician-gynaecologists in the Nordic countries and Estonia in 2015–2016. Of the participating physicians, 43% resided in Finland, 18% in Denmark, 16% in Norway, 13% in Estonia, and 10% in Sweden or Iceland, and 75% were obstetrician-gynaecologists. Multivariable logistic regression models were run to identify health care provider characteristics for awareness, diagnosis and treatment of PCOS.ResultsClinical features, lifestyle management and comorbidity were commonly recognized in women with PCOS, while impairment in psychosocial wellbeing was not well acknowledged. Over two-thirds of the physicians used the Rotterdam diagnostic criteria for PCOS. Medical endocrinologists more often recommended lifestyle management (OR = 3.6, CI 1.6–8.1) or metformin (OR = 5.0, CI 2.5–10.2), but less frequently OCP (OR = 0.5, CI 0.2–0.9) for non-fertility concerns than general obstetrician-gynaecologists. The physicians aged <35 years were 2.2 times (95% CI 1.1–4.3) more likely than older physicians to recommend lifestyle management for patients with PCOS for fertility concerns. Physicians aged 46–55 years were less likely to recommend oral contraceptive pills (OCP) for patients with PCOS than physicians aged >56 (adjusted odds ratio (OR) = 0.4, 95% CI 0.2–0.8).ConclusionDespite well-organized healthcare, awareness, diagnosis and management of PCOS is suboptimal, especially in relation to psychosocial comorbidities, among physicians in the Nordic countries and Estonia. Physicians need more education on PCOS and evidence-based information on Rotterdam diagnostic criteria, psychosocial features and treatment of PCOS, with the recently published international PCOS guideline well needed and welcomed.

Lifestyle management of polycystic ovary syndrome: a single-center study in Bosnia and Herzegovina

“…Fertility problems and pregnancy complications were reported by a lower percentage of physicians in our study (78.3% and 19.6%, respectively) than in the North Europe study (96% and 53%, respectively) [14] . This difference could be explained by the fact that participants in the North Europe study were mainly obstetrician-gynecologists.…”

“…The anxiety among women with PCOS was reported by 24% of participants in the North Europe study [14] , while it was mentioned by only one physician (2.2%) in our study. The results suggest that physicians are not fully aware of psychosocial comorbidities in women with PCOS.…”

“…The presence of diabetes mellitus and risk factors for diabetes mellitus type 2 (insulin resistance, impaired glucose tolerance, hyperinsulinemia, and metabolic syndrome) in PCOS patients were reported by 12/46 (26.1%) and 11/46 (23.9%) of participants in our study, respectively. In the North Europe study, conducted among 382 doctors (75% obstetrician-gynecologists, 25% endocrinologists; 79% women) from 6 countries, the increased risk for diabetes mellitus type 2 and insulin resistance in PCOS patients were reported by 95% and 97% of participants, respectively [14] . Although this may seem like a huge discrepancy in comparison to our data, it must be noted that prevalence of insulin resistance in PCOS patients reported in the literature range from 44% to 70% [15] , and even higher prevalence (83.3% in lean and 93.1% in overweight women) was reported among the PCOS patients presented with infertility [16] .…”

Evaluation of women knowledge and perception about polycystic ovary syndrome and its management in Jordan: A survey‐based study

“…Chandrasekhar and Brundha in 2016 surveyed that more than 80% of the population have a knowledge about some of the symptoms of PCOS 17 . Another study showed that female with PCOS recognised the symptoms and comorbidity commonly, with the exception of psychosocial impairment which was not acknowledged meticulously 18 …”

“…Teede et al showed that weight loss of 5% to 10% can have significant clinical impacts on features of the disease 20 . Furthermore, a study of obstetrician‐gynaecologists and endocrinologists awareness of PCOS demonstrated that diagnosis and management of PCOS was suboptimal among physicians, especially psychosocial comorbidities 18 . Chemerinski et al who study the knowledge of PCOS among residents physicians revealed significant gaps in knowledge about PCOS 23 …”