Hormones

Risk of PCOS over-diagnosis in young women


Many women with signs and symptoms suggestive of polycystic ovary syndrome (PCOS) can be managed without the need for an overused diagnostic label.

According to an analysis article in The BMJ, diagnostic criteria for PCOS had widened without good evidence and over-diagnosis had become a real risk.

Professor Jenny Doust, from the Centre for Research in Evidence-Based Practice at Bond University, told the limbic that the belief that PCOS was a lifetime condition persisted.

However at least three studies had shown a significant drop-off in prevalence between women in their early 20s and those approaching 30 years of age.

“I think it’s all about the way PCOS is defined,” she said.

“The signs on ultrasound are so common in young women that saying when that becomes abnormal is quite difficult. It might be we have to change the threshold for PCOS on ultrasound.”

Australian data showed the prevalence of PCOS ranged from 8.7% on NIH criteria to 17.8% on the more recent Rotterdam criteria.

“What we don’t know is how that relates to future prognosis,” Professor Doust said.

She added that symptoms such as acne and irregular periods could be managed without escalation to a diagnosis of PCOS.

“As you can imagine, there are lots of signs and symptoms that overlap with relatively normal adolescent changes in young women.”

“We need to be giving women realistic advice that if they do indeed fit the criteria for PCOS, it could be transitory and it doesn’t have to have the potential adverse consequences.”

She said there was a lack of evidence about whether a diagnostic label of PCOS could motivate behaviour change and translate to metabolic change.

However there were definite risks associated with over-managing young women with regular blood tests and ultrasounds and creating ‘fear and anxiety’ about possible risks of cardiovascular disease and infertility.

“Some people treat PCOS like a pre-diabetes but there is a question about the evidence. We need more information.”

She said one of the next steps was to look at PCOS from cohort data in the Australian Longitudinal Study on Women’s Health.

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