Background: 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.
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http://dx.doi.org/10.1111/j.1365-2265.2004.02208.x | DOI Listing |
J Clin Med
December 2024
Clinical Department of Gynecologic Surgery and Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects women of reproductive age and is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology. PCOS is often associated with hormonal imbalances, metabolic dysfunction and comorbid psychiatric disorders, including eating disorders (EDs). The review identifies key hormonal factors-serotonin, leptin, insulin, ghrelin, kisspeptin and cortisol-and their roles in the pathophysiology of PCOS and associated psychiatric symptoms.
View Article and Find Full Text PDFBreast Cancer Res Treat
November 2024
Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
Despite progress, breast cancer remains the most feared disease among women. In the USA alone, the incidence is now almost 300,000 new cancers per year, a rate that has nearly doubled in the last 30 years. Most women survive, but over 40,000 women a year still die of their disease [99].
View Article and Find Full Text PDFN Z Med J
October 2024
Endocrinologist, Department of Endocrinology, Wellington Regional Hospital, Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New Zealand; Senior Lecturer, Department of Medicine, University of Otago Wellington, New Zealand.
Aim: To determine if high normal early pregnancy HbA1c (35-40mmol/mol), in the absence of diabetes, was associated with increased risk of adverse perinatal outcomes compared to normal HbA1c (<35mmol/mol).
Method: A retrospective chart review was carried out on all singleton births in the Wellington region from 1 July 2019 to 31 December 2019. Exclusion criteria were participants domiciled outside the Wellington region, HbA1c ≥50mmol/mol, pre-existing diabetes, gestational diabetes in current pregnancy, no HbA1c performed <20 weeks or the first HbA1c was taken at ≥20 weeks.
F S Rep
September 2024
Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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