To the Editor: The views expressed by Samaras et al1 underscore the call for national guidelines on diagnosing polycystic ovary syndrome (PCOS). Insulin resistance is the underlying metabolic disturbance in most patients with PCOS, but the disease is widely under-recognised.
Our association, the Polycystic Ovarian Syndrome Association of Australia (POSAA), hears weekly from individuals who have known for months, in some cases years, that they have a serious medical problem. Yet it is through their own persistence, not a thorough history-taking, that their condition is eventually diagnosed.
“Go home, lose weight” is the usual advice, but it is neither helpful nor appropriate. There is an urgent need among health care professionals and patients for greater understanding of fertility prospects, the risk of type 2 diabetes, and the need for lifelong exercise and permanent dietary changes. Even though women with PCOS cannot change their genetic makeup, they can take personal responsibility, which is more powerful than any drug in tackling this lifelong condition.
Our members tell us that many doctors regard PCOS as an issue of reproduction, with little regard to its metabolic characteristics. All women newly diagnosed with PCOS should be screened for insulin resistance or diabetes, as early identification allows them the best possible chance of living healthy, long lives.
As the incidence of PCOS and insulin resistance is rising, there should be national agreement on diagnosis and treatment. This should include an awareness campaign on what to look for, how to diagnose metabolic problems like PCOS and insulin resistance, and, crucially, how to treat them. Guides like the one given to POSAA by Kidson and Talbot2 and that published by the Amercian Association of Clinical Endocrinologists3 should be endorsed for Australian doctors.
POSAA has agreement from the Royal Australian College of General Practitioners, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and most state health ministers on the need for guidelines on diagnosing and treating PCOS. The MJA has copies of these letters. Yet, the federal government says “there is no specific funding allocation within the Department”, and Diabetes Australia says that current National Health and Medical Research Council (NHMRC) guidelines are appropriate. POSAA believes these guidelines are outdated.
Australia’s hidden epidemic of PCOS will only grow, matched by a ballooning financial burden on taxpayers, until governments, in partnership with the medical profession and groups like POSAA, work together to improve the health prospects of women with PCOS, and their families.
- 1. Samaras K, McElduff A, Twigg SM, et al. Insulin levels in insulin resistance: phantom of the metabolic opera? Med J Aust 2006; 185: 159-161. <MJA full text>
- 2. Kidson W, Talbot JM. The polycystic ovary syndrome — a starting point, not a diagnosis. http://posaa.asn.au/files/PCOS%20Guide.pdf (accessed Jan 2007).
- 3. American Association of Clinical Endocrinologists. What every woman and her doctor should know about polycystic ovary syndrome. http://www.aace.com/public/awareness/pcos/pdf/WhatPCOS.pdf (accessed Jan 2007).
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