Analysis Too Much Medicine

Are expanding disease definitions unnecessarily labelling women with polycystic ovary syndrome?

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3694 (Published 16 August 2017) Cite this as: BMJ 2017;358:j3694
  1. Tessa Copp, PhD student12,
  2. Jesse Jansen, cognitive psychologist and senior research fellow12,
  3. Jenny Doust, GP and professor of clinical epidemiology34,
  4. Ben WJ Mol, professor of obstetrics and gynaecology56,
  5. Anuja Dokras, professor of obstetrics and gynaecology7,
  6. Kirsten McCaffery, behavioural scientist and professorial research fellow12
  1. 1Wiser Healthcare, Sydney School of Public Health, University of Sydney, NSW 2006, Australia
  2. 2Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), University of Sydney, NSW 2006, Australia
  3. 3Wiser Healthcare, Bond University, QLD 4229, Australia
  4. 4Centre for Research in Evidence-Based Practice, Bond University, QLD 4229, Australia
  5. 5Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA 5005, Australia
  6. 6The South Australian Health and Medical Research Institute, Adelaide, Australia
  7. 7Penn PCOS Centre, Department of Obstetrics and Gynaecology, University of Pennsylvania, Philadelphia, US
  1. Correspondence to: J Jansen jesse.jansen{at}sydney.edu.au

Since polycystic ovary syndrome was described in the 1930s, the diagnostic criteria have expanded and prevalence has risen, explain Tessa Copp and colleagues. But to what extent do women today benefit from their diagnosis, particularly younger women and those with milder symptoms?

Summary box

  • Clinical context—Polycystic ovary syndrome (PCOS) is the most commonly diagnosed endocrine disorder affecting reproductive aged women and is associated with adverse reproductive, metabolic, and cardiovascular outcomes

  • Diagnostic change—The Rotterdam consensus expanded the criteria from the National Institutes of Health (NIH) to include polycystic ovaries, introducing a number of different PCOS phenotypes

  • Rationale for change—Early identification, diagnosis, and management of PCOS could prevent the adverse long term implications by implementing lifestyle modifications and screening for comorbidities

  • Leap of faith—Diagnosis will provide relief to symptom burden and allow implementation of lifestyle changes to improve cardiovascular risk and increase fertility

  • Increase in disease—Estimated number of diagnoses in reproduction aged women increased from 4-6.6% for NIH criteria to 21% for Rotterdam criteria, depending on the population studied

  • Evidence of overdiagnosis—Diagnoses have rapidly increased, the criteria are of questionable use in adolescents and young women, and the non-hyperandrogenic phenotypes of PCOS do not have the same associated adverse implications as the hyperandrogenic phenotypes

  • Harms from overdiagnosis—In addition to taking long term medications, labelling healthy women with PCOS might negatively impact their psychological health and wellbeing, inducing fear and anxiety about future fertility and long term health

  • Uncertainties—Suggestion of overdiagnosis is based on the rise in diagnoses and the uncertainties that exist in the diagnosis, progression, and treatment of PCOS

  • Conclusion—A PCOS label might not be needed to effectively treat many symptoms of PCOS, as the label often does not change the type or intensity of the intervention. We recommend carefully weighing up the …

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