Gaps in knowledge in diagnosis and management of polycystic ovary syndrome.

OBJECTIVE: There is significant dissatisfaction amongst women with PCOS regarding their diagnosis and treatment experience. Australian and European data show inconsistent health professional approaches in diagnosis and treatment1,2. We conducted a survey aiming to identify the gaps in PCOS knowledge and treatment amongst reproductive endocrinologists (REI) and gynecologists (OBGYN) in North America. DESIGN: Online survey conducted through ASRM and ACOG. MATERIALS AND METHODS: The survey included questions regarding physician demographics, PCOS diagnostic criteria, key features associated with PCOS, and treatment and management practices. Pearson chi-square test was used to compare differences between groups. RESULTS: Of the 630 surveys completed by physicians residing in North America, 70.1% were OBGYN physicians (n¼442), 65.9% were females, and 83.1% were over the age of 35 years. The REI physicians treated a larger number of PCOS patients annually (50-200) compared to OBGYN physicians (67% versus 29.4%, p<0.01). Overall, 50% of physicians estimated the prevalence of PCOS to be between 11-20%. The commonest reason for a woman with PCOS to visit the REI physician was infertility (80.4%) and to visit the OBGYN was menstrual irregularity (80.4%). Only 69.4% of REI and 41.4% of OBGYN physicians used the Rotterdam criteria to establish the diagnosis of PCOS (p<0.001), while 32.1% of OBGYN compared to 2.2% of REI reported that they did not know the criteria they used to establish the diagnosis (p<0.001). However, >86% of all physicians were aware that irregular menses, high androgens, hirsutism and acne were associated with PCOS. Over one-third of physicians associated ’cysts on ovaries’ with PCOS (35% REI versus 68% OBGYN, p<0.01). The majority of responders (>85%) were aware of the cardiometabolic morbidities associated with PCOS, however fewer OBGYN physicians were aware of associated depression (49% versus 80%), anxiety disorders (23% versus 49%) and reduced quality of life (51% versus 75%) compared to REI physicians (p<0.001). Overall, less than 15% reported that women were seeing them for complaints of obesity, despite this being the number one health concern for women with PCOS. Oral contraceptive pills, lifestyle modifications and metformin were commonly recommended non-fertility treatments by all physicians however, few physicians prescribed anti-androgens or recommended laser therapy (<31% REI, <15% OBGYN, p<0.001). CONCLUSIONS: Our survey, conducted in response to patient concerns, highlights several opportunities for both REI and OBGYN physician education in improving the diagnosis of PCOS and offering more comprehensive care by increasing knowledge of internationally accepted Rotterdam diagnostic criteria, associated psychosocial co-morbidities and weight-related concerns in women with PCOS.