Encourage Early Diagnosis of Polycystic Ovary Syndrome in Adults Through Patient Education
Would it come as a surprise to learn that many women spend years visiting doctors before getting an accurate diagnosis for polycystic ovary syndrome? According to a recent survey, that’s the reality and it’s bad news because untreated polycystic ovary syndrome can lead to chronic, life-shortening disease.
Pharmacists can make a significant difference by finding ways to promote patient education and awareness about polycystic ovarian syndrome. The more women know about the symptoms, the more likely they are to see the right specialist, report all of their key health information, and achieve earlier diagnosis and treatment.
Long-Term Health Consequences of Polycystic Ovarian Syndrome
Even if you’re aware that polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, you may not know—and most women certainly don’t realize—that it touches 1 in 10 women.1 The disorder and its prevalence are cause for concern considering its impact on women, their ability to have children and their long-term health:
- PCOS is the top cause of female infertility
- PCOS increases the risk of the following health conditions:
- Type 2 diabetes – 10 percent of women with PCOS have type 2 diabetes and up to 40 percent have impaired glucose tolerance before the age of 402
- High blood pressure
- Abnormal uterine bleeding
- Endometrial hyperplasia and carcinoma
- Elevated cholesterol and triglycerides
- Metabolic syndrome – 43 percent prevalence in women with PCOS
- Cardiovascular disease
- Nonalcoholic steatohepatitis
- Psychological disorders such as depression
With such serious complications, it’s urgent to get a diagnosis and begin treatment as early as possible, but that’s not what happens for many women, according to the results of a survey published in the December 2016 issue of The Journal of Clinical Endocrinology and Metabolism. When 1,385 women diagnosed with PCOS were surveyed, it turned out that:3
- Diagnosis was delayed by two or more years for one-third of respondents.
- Nearly half of the women surveyed saw three or more health professionals before a diagnosis was established.
- 65 percent were not satisfied with their experience on the path to diagnosis.
- About 84 percent were not satisfied with the information they received after diagnosis.
One of the most telling pieces of information from the survey is that women see multiple health care providers before getting a diagnosis. It points to a reason why the diagnosis may be delayed—diverse symptoms lead women to seek help from different specialists, where the complete picture may not come together and PCOS may be missed.
Primary Symptoms and Treatment Overview
Two of the key PCOS symptoms—abnormal menstrual periods and severe acne—are common problems that may not raise red flags for a more serious underlying condition. PCOS can occur any time after puberty, so young women may assume an irregular period is normal for them. As a result, they won’t consult a doctor. Up to 95 percent of adolescents have acne. Even if it’s severe enough to go to a doctor, the attention to acne isn’t likely to be associated with missed periods.
Lack of a diagnosis means untreated PCOS and the characteristic excessive production of androgen have plenty of time to cause health problems. At least two of the first three symptoms on this list must be present to diagnose PCOS:4
- Polycystic ovaries – May be asymptomatic or cause pain and tenderness in the lower abdomen, especially during ovulation or intercourse.
- Chronic anovulation causing irregular periods – The most common characteristic of PCOS, but one that varies in each woman. Menstrual intervals may be longer than 35 days, women may have fewer than eight menstrual cycles a year, fail to menstruate for four months or longer, and have longer-than-normal periods that could be scant or heavy.
- Excess androgen – Hirsutism develops in more than 70 percent of women. High levels of androgen also cause severe adolescent acne or adult acne that doesn’t respond to normal topical treatment.
- Obesity – Weight gain is common in women with PCOS, affecting up to 80 percent of women with PCOS. One study reported that PCOS is linked to functional changes in adipose tissue and that high levels of androgen cause hypertrophy of adipocytes and inflammation.5 Research published in Scientific Reports in March 2016 concluded that women with PCOS have multiple transcriptional and epigenetic changes in adipose tissue.6
The treatment plan for PCOS takes a two-pronged approach that includes lifestyle changes and medical therapy to manage infertility, acne, hirsutism and/or obesity.
- Diet to promote weight loss – While you should be sensitive to the fact that metabolic, functional and genetic disturbances associated with PCOS make it hard to lose weight, women still need to follow a healthy weight loss plan. Losing 10 to 15 pounds helps regulate menstrual periods and improve cholesterol and insulin levels.
- Hormonal birth control – Doctors may prescribe the pill, patch, vaginal ring or hormone intrauterine device to regulate the menstrual cycle, lower the risk of endometrial cancer, improve acne and reduce hair overgrowth on the face and body.
- Anti-androgen medicines – While they’re not approved to treat PCOS, medications such as spironolactone and finasteride (second-line choice) are used to treat hirsutism.
- Metformin – Used off-label to treat insulin resistance and type 2 diabetes.
- Topical eflornithine – Helps retard hair growth but hirsutism returns if the treatment stops.
Pharmacist Outreach to Improve Patient Education
Pharmacists may learn that a woman has PCOS during prescription medication counseling, otherwise it’s hard to identify which people in your pharmacy need to know about this complex condition. Try placing pamphlets or handouts about PCOS in highly visible areas, whether at the checkout or in the sections where you sell feminine hygiene products, acne treatments, or ovulation test kits.
Patient education pamphlets and one or two pages of information you can print out are available from the PCOS Foundation7 and the Office on Women’s Health8. Any effort you take that improves awareness of PCOS can also prompt women to get an earlier diagnosis and perhaps even spare them from chronic disease.
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- “Polycystic Ovary Syndrome,” June 2016, https://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html ↩
- “Polycystic Ovarian Syndrome,” August 2016, http://emedicine.medscape.com/article/256806-overview ↩
- “Delayed Diagnosis and a Lack of Information Associated with Dissatisfaction in Women with Polycystic Ovary Syndrome,” December 2016, http://press.endocrine.org/doi/10.1210/jc.2016-2963 ↩
- “Polycystic Ovary Syndrome,” March 2015, http://www.acog.org/Patients/FAQs/Polycystic-Ovary-Syndrome-PCOS ↩
- “Adipose Tissue Dysfunction, Adipokines, and Low-Grade Chronic Inflammation in Polycystic Ovary Syndrome,” May 2015, https://www.ncbi.nlm.nih.gov/pubmed/25628442 ↩
- “Epigenetic and Transcriptional Alterations in Human Adipose Tissue of Polycystic Ovary Syndrome,” March 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791632/ ↩
- “What is PCOS?” 2011, http://www.pcosfoundation.org/PCOS-Education-trifold.pdf ↩
- “Polycystic Ovary Syndrome,” May 2016, https://www.womenshealth.gov/files/assets/docs/fact-sheets/polycystic-ovary-syndrome.pdf ↩