Disparity among Endocrinologists and Gynaecologists in the Diagnosis of Polycystic Ovarian Syndrome

Abstract

Objectives: This study aimed to compare endocrinologists’ versus gynaecologists’ approaches in using the Rotterdam criteria to diagnose polycystic ovarian syndrome (PCOS). Methods: This cross-sectional study was conducted at Physiology Department, King Saud University, Riyadh, Saudi Arabia, between December 2017 and April 2018. A validated self-administered questionnaire in English was used to obtain information from endocrinologists and gynaecologists regarding their approaches to diagnosing PCOS. Each group’s diagnostic use of the Rotterdam criteria, association between years of experience and clinical decision-making, clinical features leading to diagnosis and considerations in the diagnosis of biochemical parameters that define hyperandrogenism were evaluated. Results: A total of 132 physicians were included in this study (response rate: 27%); 77 (58.3%) were endocrinologists and 55 (41.7%) were gynaecologists. Most of the respondents (79.5%) had ≤20 years of experience. A statistically significant difference was detected between the endocrinologists and gynaecologists (98.7% versus 81.8%; P = 0.001) in their consideration of hyperandrogenism in the diagnosis. The gynaecologists relied more on ovarian morphology than the endocrinologists did (76.4% versus 45.5%, P <0.0001). Physicians with more experience used ovarian ultrasonography more compared to those with less experience (P = 0.006). Conclusion: There was disparity in the diagnostic approaches of endocrinologists, who rely more on androgen levels for diagnosis of PCOS versus gynaecologists, who more frequently use an ovarian morphology assessment. Increased years of experience increased the rate of ultrasonography use for PCOS diagnosis in both groups.Keywords: Polycystic Ovary Syndrome; Gynecology; Endocrinology; Diagnosis; Hyperandrogenism; Hirsutism; Healthcare Disparities; Saudi Arabia.

Bridging the Information Gap in Polycystic Ovary Syndrome: A Narrative Review with Systematic Approach

“…In a small survey study out of Saudi Arabia, endocrinologists reported greater reliance on hyperandrogenism and gynecologists more frequently used ultrasound in application of the Rotterdam criteria. 45 A large physician survey ( n = 1,318) out of China examined the implementation of metabolic screening recommendations from the 2018 International PCOS Guideline in general obstetrician–gynecologists (85.8%) and reproductive endocrinologists (14.2%). 46 Despite their low representation in this sample, reproductive endocrinologists were significantly more likely to order oral glucose tolerance test and lipid testing and prescribe metformin in patients with fertility demands.…”

Diagnosis and Management of Polycystic Ovary Syndrome: A Survey of Physicians from the Middle East and Africa

“…Nonetheless, a comparison between endocrinologists and gynecologists was not the primary objective of the present study, and it has been specifically addressed in previous studies. [22][23][24] Other limitations include introducing a selection bias as only those interested in PCOS could have attempted the survey. It is worth noting that the low response rate may have been attributed to the study period, which coincided with the initial outbreak of the coronavirus disease 2019 pandemic and the generally reduced attention to research activities beyond the pandemic Furthermore, the wide difference in the responses concerning the ultrasound criteria can be attributed to the potential phrasing ambiguity in identifying PCO morphology by ultrasound by transabdominal versus transvaginal approaches.…”

“…Most of the responses were from the Arabian Gulf (64.7%), followed by the rest of the Middle East (18.4%) and North Africa (10.5%) (►Table 1). However, most of the responses were from four countries: Saudi Arabia (59), Qatar (33), Iraq (33), and the United Arab Emirates (22). This was followed in decreasing order by Egypt (7), Sudan (6), South Africa (5), Libya (5), Bahrain (4), Nigeria (3), Lebanon (2), Morocco (2), Oman (2), Kenya (2), Kuwait (2), Mali (1), Uganda (1), and Zimbabwe (1).…”

Effect of Consultation Number on the Assessment and Treatment of Polycystic Ovary Syndrome

“…24 Studies have documented differences in the diagnosis of PCOS among physicians with different experiences. 25 Our study focuses on the factors of patient turnover of physicians, aiming to find the influence on the ability of doctors. Through comprehensive evaluation of diagnosis and treatment capacity, we can find and narrow the disparities, and promote the overall improvement of the medical level.…”