For information on a particular condition or topic try our health Topic Finder with links to this and other Jean Hailes websites or use the website search function.
Everyday lifestyle changes are a more realistic and effective way than dieting to manage weight and prevent long-term weight gain.
Health Professionals Medical Observer Polycystic ovary syndrome - 23 April, 2010
Polycystic ovary syndrome - 23 April, 2010
| 
Polycystic ovary syndrome (PCOS) affects 12 to 18 per cent of women of reproductive age and is of clinical and public health importance. PCOS can be a frustrating experience for women, a complex syndrome for clinicians and a scientific challenge for researchers. Disturbingly, around 70% of PCOS cases are currently undiagnosed in Australia1 and research by our unit has shown diagnosis may be delayed by up to two years.
With such high prevalence, impact across the lifespan and manifestations that cross health care disciplines, PCOS management should rest predominantly in primary care.
The syndrome has significant and diverse clinical implications:
- Reproductive: hyperandrogenism, hirsutism, anovulation, infertility
- Metabolic: insulin resistance, impaired glucose tolerance, type 2 diabetes, adverse cardiovascular risk profiles
- Psychological: increased anxiety depression and worsened quality of life.
Author Professor Helena Teede |
Diagnosis
Diagnosis requires two of three key features:
- oligomenorrhoea/amenorrhoea
- clinical or biochemical hyperandrogenism
- polycystic ovaries on ultrasound.
Table 1: Recommended investigations in PCOS include: |
|
The PCOS phenotype varies widely depending on life stage, genotype, ethnicity and environmental factors, including lifestyle and bodyweight.
While PCOS can occur in lean individuals, obesity-induced insulin resistance exacerbates prevalence and clinical features of PCOS. An OGTT and lipid profile are important at baseline and should be repeated with frequency determined by metabolic risk (e.g. body weight, age, family history, ethnicity).
An OGTT is preferable to fasting glucose as it detects prediabetes as well as diabetes.
Management
Therapy should focus on the short and long-term reproductive, metabolic and psychological features. Given the aetiological role of insulin resistance and obesity in PCOS, lifestyle management aimed at reducing and preventing weight gain is recognised as first line in the majority of women who are overweight.2
Modest weight loss of 5 to10 per cent of initial body weight reduces insulin resistance dramatically and improves reproductive and metabolic features of PCOS.2 It may be useful to implement health-coaching principles to assess readiness and motivation to change and set realistic and achievable goals (e.g. 5% reduction of body weight, small improvements in exercise), rather than setting a single unattainable goal (e.g. of normalisation of body weight) which, if it is not achieved, may induce feelings of failure and guilt.
To facilitate this, anxiety, depression and demoralisation need to be addressed as part of the psychological management of PCOS.
Multidisciplinary management should focus on support, education, addressing psychological factors and a strong emphasis on a healthy lifestyle with targeted medical therapy as required (summarised in Table 2).
The Jean Hailes Foundation for Women’s Health supported the formation of a National PCOS Alliance, bringing together health professionals, researchers, consumers and policy makers to advance knowledge and quality of care in PCOS. The Federal Government has funded the alliance to produce national evidence-based guidelines, and to translate these into practice.
The foundation provides independent evidence-based information for health professionals and women through a national government-funded education program at http://www.managingpcos.org.au/.
Table 2: Targeted treatment options in PCOS |
Oligomenorrhoea/amenorrhoea
Hirsutism
Infertility
*Metformin and indeed the OCP are not currently approved for use to manage PCOS by many regulatory bodies. The OCP is indicated for contraception and metformin for diabetes. However, their use is recommended by international and national specialist societies and is evidence based.4 |
Polycystic Ovary Syndrome 141.92 Kb
References
1. March WA, Moore VM, Willson KJ, Phillips DIW, Norman RJ, Davies MJ 2010 The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 25:544-551
2. Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ 2009 Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril 92:1966-1982
3. Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E, Nathan D 2002 Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New Engl J Med 346:393-403
4. Teede H, Hutchison SK, Zoungas S 2007 The management of insulin resistance in polycystic ovary syndrome. Trends Endocrinol Metab 18:273-279
Content Updated April 30, 2010
 |
Our websites
Search this website
Email updates
GP & HP Webcast
Community webcasts
Follow us
 |
 |
 |
 |
 |
