Is polycystic ovary syndrome appropriately diagnosed by obstetricians and gynaecologists across China: a nationwide survey

Abstract

Background To describe the diagnostic criteria used and their application accuracy in the practice of polycystic ovary syndrome (PCOS) caring among obstetricians and gynaecologists across China. Methods This was an Online cross-sectional survey of Obstetricians and gynecologists involved in PCOS caring conducted via the largest continuing education platform of obstetrics and gynecology across China from September 2019 to November 2019. Results A total of 2,328 respondents were eligible for the final analysis. Of these, 94.5 % were general obstetricians and gynaecologists (Ge-ObGyn), and 5.5 % were reproductive endocrinologists (Re-ObGyn). Overall, the most frequently used criteria were the Androgen Excess and Polycystic Ovary Syndrome Society (AE-PCOS) criteria (48.2 %), followed by the Rotterdam criteria (35.7 %) and NIH criteria (12.1 %). Of the respondents, 31.3 % used their diagnostic criteria in their clinical practice. More respondents who chose the Rotterdam criteria could accurately apply the diagnostic criteria than those who chose the AE-PCOS criteria (41.2 % vs. 32.1 %, P < 0.001). Compared with Ge-ObGyn, Re-ObGyn were less likely to use the AE-PCOS criteria (adjusted odds ratio, 0.513; 95 % CI, 0.328–0.802; P < 0.05) and 1.492 times more likely to accurately use their criteria (95 % CI, 1.014–2.196; P < 0.05). Conclusions Less than one-third of obstetricians and gynaecologists across China could accurately use the diagnostic criteria they choose to diagnose PCOS. There is an urgent need to train obstetricians and gynaecologists on PCOS diagnosis in an effort to improve the medical care quality of patients with PCOS.

What can be done to improve polycystic ovary syndrome (PCOS) healthcare? Insights from semi-structured interviews with women in Canada

“…Little is known about levels of knowledge of PCOS in primary care. Most studies pointing to significant gaps in knowledge in physicians have examined obstetrician-gynecology and endocrinology residents and physicians, finding many not knowing which PCOS diagnostic criteria they used or being unable to correctly identify diagnostic criteria [ 17 , 19 , 21 ]. A 2018 study found that women had greater levels of distrust in their PCP’s opinion and felt that they spent less effort treating their PCOS concerns [ 25 ], and another study found that women received little information about long-term PCOS implications from their GPs [ 30 ].…”

“…There appear to be widespread gaps in knowledge and inconsistent approaches among residents and physicians on the diagnosis and management of PCOS [ 17 – 21 ]. A recent study with physicians revealed some difficulty and confusion with PCOS care, as the spectrum of PCOS presentation can make it hard to determine appropriate diagnosis and management [ 22 ].…”

Diagnosis and management of polycystic ovary syndrome: Perspectives of clinicians in Singapore

“…20 Clinicians from China were also found to have a low accurate application rate (31.3%) of their chosen diagnostic criteria. 7 These findings highlight the knowledge gap present in identifying the correct clinical features of PCOS, and discrepancies in the diagnostic criteria used.…”

“…6,21 On the other hand, a recent study found that the AE-PCOS criteria was most frequently used to diagnose PCOS in China. 7…”

“…2,4,5 The situation is aggravated by a plethora of definitions that professional societies and organisations use to diagnose PCOS. [6][7][8][9][10][11] The 1990 National Institutes of Health (NIH) criteria require hyperandrogenism, either clinical (Ferriman-Gallwey score ≥8) or biochemical hyperandrogenism (elevated total or free testosterone)…”