Hormones

Management of PCOS requires a holistic approach


Endocrinologists are being urged to take a holistic approach to the way they manage their patients with polycystic ovary syndrome in new Australian led guidelines.

The international guidelines published this month in the journal Fertility and Sterility  on the management of PCOS are intended to raise awareness of depression, anxiety, quality of life and eating disorders often experienced by women living with the condition.

Speaking to the limbic, study author and Melbourne endocrinologist Professor Helena Teede, director of the Monash Centre for Health Research and Implementation, says the guidelines aim to address the gaps in knowledge among those who have and treat the chronic condition, in order to drive up earlier diagnosis and screening for complications.

The position statement recommends routine screening for anxiety and depression, more prevalent in women with PCOS than controls. If the screen is negative it should be repeated in women who are at higher risk due to associated factors like obesity or a family history.

“The screening is simple, we actually use a one-page tick box that women do in the waiting room,” Professor Teede said.

“We have a few simple questions that we ask and if any of those trigger a response that’s a concern, it needs more attention and may require referral.”

Importantly, it appears that the associated features of PCOS – like weight gain and hirsutism themselves – rather than the condition itself are driving poor mental health outcomes.

One randomised controlled trial found a significant reduction in depression and anxiety in women six months after they had laser hair removal, compared to a control group.

“It’s really important when we talk about this, that we don’t just talk about the clinical features but also that there’s hope and we can treat the majority of them very effectively,” Professor Teede said.

“Yes, there’s women who have infertility but they can have, and often do have, the same family size as women without the condition. They just need a bit of help. Yes, they have more anxiety and depression, but if we screen for it and detect it and we treat the features of the condition, the anxiety and depression can improve.”

Moving forward it will be important to increase access to public services for the typically expensive laser hair removal and fertility support, she said.

“There is a need for all health care providers to be better informed, there is a need for women to be stronger self- advocates with better health literacy and there is a need for support services that provide them with the best models of care.”

“For endocrinologists the most important thing is to be aware of the psychosocial impacts of the condition, to take a wholistic approach across all the features of the condition, not necessarily just those that are related to the endocrine component.”

The document is part of a larger set of international guidelines on the management of PCOS due to be released on July 2, driven by Monash, which is accompanied by a suite of evidence-based resources for patients and healthcare professionals including a consumer app and CPD education.

The work is backed by 71 countries and has been endorsed by Australian doctors’ groups including the Endocrine Society of Australia and the RACP.

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