New International Medical Guideline for PCOS: What You Need to Know (Pt. 1)
NEW INTERNATIONAL MEDICAL GUIDELINES FOR PCOS: WHAT YOU NEED TO KNOW (Part 1)
A doctor’s perspective on the recently released guideline aimed at streamlining the diagnosis and treatment of PCOS
It’s Polycystic Ovary Syndrome (PCOS) Awareness Month, which aims to educate women and the public about a syndrome that affects as many as one in ten women in the U.S. and is a leading cause of infertility. PCOS is a serious condition; in addition to symptoms that can have a big impact on women’s self esteem and body image like hirsutism (the development of male-pattern hair growth in women) and difficulties like irregular menstruation, it also raises a woman’s risk of type 2 diabetes, heightens her risk of anxiety and depression, and more.
Doctors face difficulties when trying to effectively and efficiently diagnose and treat PCOS because there has been a lot of disagreement in the medical community over the condition’s diagnostic criteria and treatment protocol.
Thankfully, women have good reason to believe that change is coming. A new medical guideline, launched internationally this summer, aims to streamline diagnosis and care for women with PCOS.
We sat down with Dr. Michael Homer of the Reproductive Science Center in the San Francisco Bay Area to hear a doctor’s perspective on this new guideline and its impact.
Celmatix: In a blog post we published last September, you shared that part of the difficulty of diagnosing PCOS “…lies in the fact that there are four national and international organizations that define PCOS differently,” and pointed out some discrepancies in the various criteria these organizations relied on to make a diagnosis. How do you feel this guideline will help solve this issue?
Dr. Homer: First of all, the guideline is the most comprehensive update yet. Thirty-seven organizations covering 76 countries were involved in 20 face-to-face meetings over 15 months. So to say it was thorough is an understatement!
In covering the latest evidence and bringing together top academics and practitioners from around the globe, including the previously mentioned societies, this international guideline should help to set the direction of PCOS research for years to come.
It will also allow patients to see consistency with their care when seeing different providers as it should now be considered the new benchmark.
Secondly, the organizations behind the guideline did endorse a single PCOS diagnostic criteria (Rotterdam) for adults which is two of the following: irregular or no periods, clinical and/or biochemical signs of high androgens like testosterone, or polycystic ovaries on ultrasound. They also reinforced the key distinction that adolescents should be diagnosed differently than adults, with a recommendation against ultrasound in those within 8 years of their first menstrual period to avoid over-diagnosis.
Lastly, this comprehensive review will create headlines and bring much-needed attention to PCOS, which in turn will help PCOS organizations create more discussions centered on updated and verified information. This will also hopefully reduce patients’ reliance upon poorly sourced PCOS “solutions” and other methodologies that are not helpful or confuse the issue.
Celmatix: Beyond this guideline, what, if anything, is needed to improve the diagnosis and treatment of PCOS?
Dr. Homer: Honestly? Compassion and thoughtfulness on behalf of the physicians and care providers. Here’s a common example that I read online and hear in my office: “The doctor didn’t seem to think it was a big deal and said just take birth control pills.”
The strange part is that for many women with PCOS not seeking pregnancy, birth control pills are one of the best treatments! However, some doctors who may not understand the nuances of PCOS see it as such an obvious answer,so they may not take the time to explain to the patient why birth control pills work so well. Or perhaps they aren’t acknowledging and exploring the real impact that this diagnosis is having on a woman’s life and making sure that the patient is comfortable with birth control pills or other forms of treatment.
I have found that when a woman believes she has PCOS or doesn’t feel that her body is “in synch,” giving that patient insight into how the reproductive system works and where treatments help in that process can provide tremendous comfort.
This restores a sense of control back to the patient who might otherwise feel that her body is not in control.
Celmatix: Assuming it may take some time for this new guideline to be adopted widely and consistently, what can PCOS patients do to advocate for themselves when seeking a diagnosis or treatment?
Dr. Homer: READ! But read smart! If you are reading this, then you now have excellently sourced knowledge from this great new guideline that can help guide your care. It is important to remember not to stray from good sources. This guideline is brand new, which means that many doctors will become aware of and review it in the next few months. Take 10 minutes right now to review the guideline. The points are all fairly easy to understand and each one is important. You can even use some of these as talking points to your physician to help address your concerns. And if you find yourself with a doctor who isn’t aware, let them know and ask to chat again in a week or two, or even perhaps move on to a different care provider if you feel the proper steps aren’t being taken.
The best relationships between a patient and care provider are two-way streets. This means that you both have to be comfortable with your care direction. Ensuring that you’re happy with your provider is one of the best ways to advocate for yourself!
Dr. Michael Homer is a Reproductive Endocrinologist at the Reproductive Science Center (RSC) in the San Francisco Bay area, where he specializes in polycystic ovary syndrome and oncofertility, as well as serving the LGBTQ community. You can learn more about Dr. Homer and RSC here.