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

Terhi T. Piltonen, Maria Ruokojärvi, Helle Karro, Linda Kujanpää, Laure Morin-Papunen, Juha S. Tapanainen, Elisabet Stener-Victorin, Inger Sundrström-Poromaa, Angelica L. Hirschberg, Pernille Ravn, Dorte Glintborg, Jan Roar Mellembakken, Thora Steingrimsdottir, Melanie Gibson-Helm, Eszter Vanky, Marianne Andersen, Riikka K. Arffman, Helena Teede, Kobra Falah-Hassani

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Objective To 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. Methods This 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. Results Clinical 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 nonfertility 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). Conclusion Despite 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.

Original languageEnglish
Article numbere0226074
Number of pages12
JournalPLoS ONE
Issue number12
Publication statusPublished - 26 Dec 2019

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Piltonen, T. T., Ruokojärvi, M., Karro, H., Kujanpää, L., Morin-Papunen, L., Tapanainen, J. S., Stener-Victorin, E., Sundrström-Poromaa, I., Hirschberg, A. L., Ravn, P., Glintborg, D., Mellembakken, J. R., Steingrimsdottir, T., Gibson-Helm, M., Vanky, E., Andersen, M., Arffman, R. K., Teede, H., & Falah-Hassani, K. (2019). Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe. PLoS ONE, 14(12), [e0226074].