Polycystic ovarian syndrome: marked differences between endocrinologists and gynaecologists in diagnosis and management
- 25 January 2005
- journal article
- research article
- Published by Wiley in Clinical Endocrinology
- Vol. 62 (3), 289-295
- https://doi.org/10.1111/j.1365-2265.2004.02208.x
Abstract
The definitive version is available at www.blackwell-synergy.comBackground Women with polycystic ovarian syndrome (PCOS) commonly consult endocrinologists or gynaecologists and it is not known whether these specialty groups differ in their approach to management. Objective To compare the investigation, diagnosis and treatment practices of endocrinologists and gynaecologists who treat PCOS. Design and Setting A mailed questionnaire containing a hypothetical patient's case history with varying presentations − oligomenorrhoea, hirsutism, infertility and obesity − was sent to Australian clinical endocrinologists and gynaecologists in teaching hospitals and private practice. Results Evaluable responses were obtained from 138 endocrinologists and 172 gynaecologists. The two specialty groups differed in their choice of essential diagnostic criteria and investigations. Endocrinologists regarded androgenization (81%) and menstrual irregularity (70%) as essential diagnostic criteria, whereas gynaecologists required polycystic ovaries (61%), androgenization (59%), menstrual irregularity (47%) and an elevated LH/FSH ratio (47%) (all P-values < 0·001). In investigation, gynaecologists were more likely to request ovarian ultrasound (91%vs. 44%, P < 0·001) and endocrinologists more likely to measure adrenal androgens (80%vs. 58%, P < 0·001) and lipids (67%vs. 34%, P < 0·001). Gynaecologists were less likely to assess glucose homeostasis but more likely to use a glucose tolerance test to do so. Diet and exercise were chosen by most respondents as first-line treatment for all presentations. However, endocrinologists were more likely to use insulin sensitizers, particularly metformin, for these indications. In particular, for infertility, endocrinologists favoured metformin treatment whereas gynaecologists recommended clomiphene. Conclusions There is a lack of consensus between endocrinologists and gynaecologists in the definition, diagnosis and treatment of PCOS. As a consequence, women may receive a different diagnosis or treatment depending on the type of specialist consulted.Andrea J. Cussons, Bronwyn G. A. Stuckey, John P. Walsh, Valerie Burke and Robert J. NormaKeywords
This publication has 53 references indexed in Scilit:
- LH levels in women with polycystic ovarian syndrome: have modern assays made them irrelevant?BJOG: An International Journal of Obstetrics and Gynaecology, 2003
- Differences between endocrine surgeons and endocrinologists in the management of non-toxic multinodular goitreBritish Journal of Surgery, 2003
- Altered Vascular Function in Young Women with Polycystic Ovary SyndromeJournal of Clinical Endocrinology & Metabolism, 2002
- Effect of Long-Term Treatment with Metformin Added to Hypocaloric Diet on Body Composition, Fat Distribution, and Androgen and Insulin Levels in Abdominally Obese Women with and without the Polycystic Ovary SyndromeJournal of Clinical Endocrinology & Metabolism, 2000
- Prevalence and Predictors of Risk for Type 2 Diabetes Mellitus and Impaired Glucose Tolerance in Polycystic Ovary Syndrome: A Prospective, Controlled Study in 254 Affected WomenJournal of Clinical Endocrinology & Metabolism, 1999
- Polcystic ovary syndrome and implications for the menopauseClimacteric, 1999
- Dyslipidaemia is associated with insulin resistance in women with polycystic ovariesClinical Endocrinology, 1996
- Metabolic effects of oral contraceptives in women with polycystic ovary syndromeJournal of Clinical Endocrinology & Metabolism, 1995
- Effects of diet and metformin administration on sex hormone-binding globulin, androgens, and insulin in hirsute and obese womenJournal of Clinical Endocrinology & Metabolism, 1995