Inconsistent PCOS diagnosis, management seen in SG clinicians

A recent study assessing the diagnostic and management processes of polycystic ovary syndrome (PCOS) adopted by clinicians from different specialties in Singapore has found certain variations, which warrant the need for standardized workplace protocols and patient education resources.

“This is the first study to the best of our knowledge that gives an insight into the diagnostic and management processes of PCOS among various healthcare institutions in Singapore,” the researchers said. “It is anticipated that similar conundrums are faced by patients in Singapore as the patients worldwide.”

A cross-sectional survey was conducted involving 208 clinicians from specific subspecialties across various healthcare settings in Singapore. Some 160 responses made it to the final analysis.

Majority of the respondents (66.3 percent) used the Rotterdam 2003 criteria in their diagnosis. More than half of the gynaecologists reported having a standardized workplace protocol, but most of the other specialties reported otherwise. [Ann Acad Med Singap 2022;51:204-212]

This finding was consistent with that in studies performed in Europe and North America, showing most clinicians still using the Rotterdam criteria. Meanwhile, in China, the most frequently used criteria were those of the Androgen Excess and PCOS Society. [Fertil Steril 2017;107:1380-86.e1; J Ovarian Res 2021;14:25; Semin Reprod Med 2018;36:19-27]

One worrisome finding was the large proportion of clinicians (60.5 percent) who could not identify the correct PCOS features. Only a few respondents (8.8 percent) utilized clinical and biochemical hyperandrogenism, menstrual disturbances, and pelvic ultrasound to diagnose PCOS without performing unnecessary and incorrect examinations.

On the other hand, most clinicians were able to identify insulin resistance/type 2 diabetes mellitus and fertility problems as complications, but only a few succeeded in recognizing psychological complications.

Notably, 37.3 percent of clinicians sought standardization of PCOS diagnosis and management guidelines to improve care, while 81.9 percent of respondents wanted to have standardized educational materials as well. Moreover, 31.3 percent of respondents did not offer any counseling, while only 16 percent used evidence-based guidelines and institution pamphlets for counseling.

“Easier access to educational resources regarding PCOS and its complications would promote greater understanding of the condition, which will in turn increase patient compliance to lifestyle modifications and other treatment plans,” the researchers said. [J Clin Endocrinol Metab 2017;102:604-612]

“This would be highly desirable given that noncompliance to lifestyle modifications was highlighted to be one of the main challenges for clinicians,” they added.

In addition, residency committees could include more training hours and clinical exposure to PCOS in endocrine, family medicine, and gynaecology residency programmes. Clinicians could also be updated about PCOS guidelines through workshops, webinars, and flexible learning opportunities, such as online PCOS courses by established and accredited platforms. [Semin Reprod Med 2018;36:66-72]

“Creating consolidated and standardized resources for all clinicians and patients across Singapore may further harmonize workflow and protocols,” the researchers said.