Knowledge and Management Practices About Polycystic Ovarian Syndrome Among Health Care Providers in Mumbai, India: A Cross-Sectional Study
Abstract
Background: Polycystic Ovary Syndrome (PCOS) diagnosis is very complex and due to overlapping presentation of symptoms, women with PCOS may approach various practitioners, who might be using varied definitions to diagnose and manage PCOS.
Objectives: To assess knowledge about PCOS diagnosis and management by Dermatologists, Gynecologists, Endocrinologists and Family Physicians (FPs).
Methods: This cross-sectional study was done among 529 health care providers (HCPs) practicing in Mumbai metropolitan region using a convenient sample. A self-administered pretested questionnaire was filled by the HCPs after obtaining informed consent. Pearson’s Chi-square test and Analysis of Variance (ANOVA) was used to study the differences within each group.
Results: All HCPs reported that women with PCOS consulted them with a varied spectrum of symptoms. Among FPs, Allopaths had better knowledge about diagnosis and Homeopaths were more confident about PCOS management. Among Specialists, Endocrinologists were more stringent in diagnosing cases as per defined criteria, along with screening and comprehensive management of the metabolic syndrome. Although the need for multidisciplinary management was perceived, in practice holistic management was not common.
Conclusions: This study reveals the need for training and disseminating algorithms for comprehensive PCOS management across disciplines. It highlights women’s preferences in seeking health care for symptom complex of PCOS. These findings would help health policymakers to develop community-based awareness modules and India-specific management guidelines for early screening and a continuum of care for PCOS patients.
Conflict of Interest: The authors have no conflicts of interest to declare that are relevant to the content of this manuscript.
Source of Support: This study was conducted as an Intramural project of ICMR-NIRRH and hence there was no sourced funding agency and no financial conflicts.
References
2. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec 15;380(9859):2163-96. Erratum in: Lancet. 2013 Feb 23;381(9867):628. AlMazroa, Mohammad A [added]; Memish, Ziad A [added].
3. Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of polycystic ovarian syndrome in Indian adolescents. J Pediatr Adolesc Gynecol. 2011 Aug;24(4):223-7. Epub 2011 May 19.
4. Joshi B, Mukherjee S, Patil A, Purandare A, Chauhan S,Vaidya R. A cross-sectional study of polycystic ovarian syndrome among adolescent and young girls in Mumbai, India. Indian J Endocrinol Metab. 2014 May;18(3):317-24.
5. Dokras A, Saini S, Gibson-Helm M, Schulkin J, Cooney L, Teede H. Gaps in knowledge among physicians regarding diagnostic criteria and management of polycystic ovary syndrome. Fertil Steril. 2017 Jun;107(6):1380-1386.e1. Epub 2017 May 5.
6. Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed Diagnosis and a Lack of Information Associated With Dissatisfaction in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2017 Feb 1;102(2):604-612.
7. Piltonen TT, Ruokojärvi M, Karro H, Kujanpää L, Morin- Papunen L, Tapanainen JS, et al. Awareness of polycystic ovary syndrome among obstetrician-gynecologists and endocrinologists in Northern Europe. PLoS One. 2019 Dec 26;14(12): e0226074.
8. Blackshaw LCD, Chhour I, Stepto NK, Lim SS. Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review. Med Sci (Basel). 2019 Jun 27;7(7):76.
9. Arasu A, Moran LJ, Robinson T, Boyle J, Lim S. Barriers and Facilitators to Weight and Lifestyle Management in Women with Polycystic Ovary Syndrome: General Practitioners’ Perspectives. Nutrients. 2019 May 7;11(5):1024.
10. Lin AW, Bergomi EJ, Dollahite JS, Sobal J, Hoeger KM, Lujan ME. Trust in Physicians and Medical Experience Beliefs Differ Between Women With and Without Polycystic Ovary Syndrome. J Endocr Soc. 2018 Aug 1;2(9):1001-1009.
11. Geense WW, van de Glind IM, Visscher TL, van Achterberg T. Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study. BMC Fam Pract. 2013 Feb 9; 14:20.
12. Rodgers RJ, Avery JC, Moore VM, Davies MJ, Azziz R, Stener-Victorin E, et al. Complex diseases and co-morbidities: polycystic ovary syndrome and type 2 diabetes mellitus. Endocr Connect. 2019 Mar;8(3): R71-R75.
13. Asante A, Omurtag K, Stewart EA, Coddington CC. Screening for Insulin Resistance in Polycystic Ovary Syndrome: Views of Physician Members of the American
Society for Reproductive Medicine. J Reprod Med. 2015 Sep- Oct;60(9-10):371-7.
14. Doll I, Doll R, Buhling KJ. Diagnosis and therapy of polycystic ovarian syndrome: results of a survey among German gynecologists with a review on literature. Arch Gynecol Obstet. 2012 Mar;285(3):689-97. Epub 2011 Aug 10.
15. Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar- Morreale HF, Franks S, Gambineri A, et al. ESE PCOS Special Interest Group. European survey of diagnosis and management of the polycystic ovary syndrome: results ofthe ESE PCOS Special Interest Group’s Questionnaire. Eur J Endocrinol. 2014 Oct;171(4):489-98. Epub 2014 Jul 21.
16. Charifson MA, Trumble BC. Evolutionary origins of polycystic ovary syndrome: An environmental mismatch disorder. Evol Med Public Health. 2019 Mar 26;2019(1):50-63.
17. Hillman JK, Johnson LN, Limaye M, Feldman RA, Sammel M, Dokras A. Black women with polycystic ovary syndrome (PCOS) have increased risk for metabolic syndrome and cardiovascular disease compared with white women with PCOS [corrected]. Fertil Steril. 2014 Feb;101(2):530-5. Epub 2013 Dec 30. Erratum in: Fertil Steril. 2014 Jun;101(6):1791.
18. Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012 Nov-Dec;18(6):618-37. Epub 2012 Jul 4.
19. Goyal M, Dawood AS. Debates Regarding Lean Patients with Polycystic Ovary Syndrome: A Narrative Review. J Hum Reprod Sci. 2017 Jul-Sep;10(3):154-161.
20. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018 Aug;110(3):364-379. Epub 2018 Jul 19.
21. Ding T, Baio G, Hardiman PJ, Petersen I, Sammon C. Diagnosis and management of polycystic ovary syndrome in the UK (2004-2014): a retrospective cohort study. BMJ Open. 2016 Jul 11;6(7): e012461
22. Teede H, Gibson-Helm M, Norman RJ, Boyle J. Polycystic ovary syndrome: perceptions and attitudes of women and primary health care physicians on features of PCOS and renaming the syndrome. J Clin Endocrinol Metab. 2014 Jan;99(1): E107-11. Epub 2013 Dec 20.
23. Lin AW, Bergomi EJ, Dollahite JS, Sobal J, Hoeger KM, Lujan ME. Trust in Physicians and Medical Experience Beliefs Differ Between Women With and Without Polycystic Ovary Syndrome. J Endocr Soc. 2018 Aug 1;2(9):1001-1009
