Assessment and Management of Women with Polycystic Ovary Syndrome (PCOS)

Abstract

Polycystic ovary syndrome (PCOS) is a complex, common endocrine condition affecting reproductive aged women with a reported prevalence of between 8 and 13%, depending on the diagnostic criteria and the population studied. Diagnosis, based on Rotterdam criteria, commonly requires two of the three following features: oligo/amenorrhoea, polycystic ovaries on ultrasound, biochemical/or clinical hyperandrogenism, with exclusion of other aetiologies. Nurses are ideally situated to provide evidence-based care and education within an interdisciplinary model to optimise the health outcomes of women with PCOS.

PCOS affects health and well-being over the lifespan. The presentation of PCOS can be heterogeneous with reproductive (hyperandrogenism, anovulation, and subfertility), metabolic (dyslipidaemia, type 2 diabetes, and CVD risk factors), and psychological features (depression, anxiety, and poor self-esteem). Women with PCOS are also predisposed to weight gain, which in turn increases PCOS prevalence and exacerbates its severity. PCOS is underpinned by intrinsic insulin resistance. Obesity exacerbates insulin resistance, and lifestyle modification alleviates this feature.

Despite the high prevalence of PCOS many women with PCOS remain undiagnosed, clinical practice is inconsistent, psychological issues are neglected, and there is little focus on lifestyle modification and chronic disease prevention with most services targeting fertility and offering costly assisted reproductive technology. In addition, women report dissatisfaction with diagnosis experiences, poor quality information, and inadequate support.

Given the multi-system dimensions of PCOS and duration of impact over the lifespan, PCOS places a large financial burden on health systems with affected women also suffering the social costs of stigmatisation and isolation, largely due to non-conformity with societal expectations relating to femininity and fecundity. In addition, due to the diversity of PCOS health impacts, affected women may be marginalised within the health system and often fall between the gaps in a speciality-focused health care system, with knowledge gaps among practitioners and, inconsistency in care delivered. In the primary care sector, health practitioners report feeling confused and ill equipped to manage PCOS, listing PCOS as the highest priority for education in women’s health. With women feeling isolated, disempowered, and underserviced, PCOS places a personal burden on affected women and their significant others, and highlights the lack of systemic, evidence-based responsiveness to their needs. This chapter provides an overview of PCOS for endocrine nurses who can play a critical role in providing evidence-based, person-centred care, within an interdisciplinary, biopsychosocial model of care.