Women with a common ovary problem should be screened for blood sugar and cholesterol problems, but a new survey of obstetricians and gynecologists found few were ordering those tests.
In the U.S., up to 12 percent of women have poly cystic ovarian syndrome (PCOS), a hormone disorder that causes irregular periods, acne, weight gain, and difficulty getting pregnant. Most women with PCOS have multiple cysts on their ovaries.
They're also at increased risk for cholesterol and blood sugar problems, the researchers write in the American Journal of Obstetrics and Gynecology.
“Recognition of these abnormalities can allow the provider and the patient to work together to determine the next steps in health care improvement including nutritional changes and exercise, weight loss, starting a medication, and/or referral to a specialist,” said lead author Dr. Amy Dhesi of Kaiser Permanente Los Angeles Medical Center.
The American Congress of Obstetricians and Gynecologists (ACOG) recommends that all women with PCOS get screened every two to five years for high blood sugar and every two years for high cholesterol.
The tests recommended are a 2-hour glucose tolerance test and a fasting lipid profile, but many doctors use less sensitive blood sugar tests that may not pick up on early issues.
In an online survey, Dhesi and her team asked gynecologists what tests, if any, they would order for PCOS patients at a first visit, and what follow-up tests they would conduct.
The research team got complete responses from 157 physicians. About half said at least 10 percent of their patients have PCOS. About 22 percent said they would not order any screening test at the first visit for at least half of their PCOS patients.
The most common tests doctors used to screen for blood sugar issues in PCOS patients were the less sensitive hemoglobin A1C, which shows the average blood sugar level over the past few months, and fasting glucose tests. Only 7 percent said they would order a 2-hour glucose test for at least the majority of their PCOS patients at the first visit.
The doctors were more compliant with cholesterol testing recommendations; 54 percent said they would order a fasting lipid profile in at least half of their PCOS patients.
Only nine of the doctors said they typically order both a lipid profile and a 2-hour oral glucose tolerance test at the initial visit for most patients with PCOS. The main reason doctors gave for not ordering 2-hour oral glucose tolerance tests was that it's inconvenient for patients. Also, more than one in five doctors said glucose test results would not affect how they treat the patient.
Most said they wouldn't order a repeat blood sugar test unless the patient's medical history changed. But 76 percent said they would order repeat cholesterol tests even in PCOS patients with normal cholesterol levels.
Dr. Richard Legro, vice-chair of research at Penn State University College of Medicine in Hershey, emphasized the importance of catching blood sugar and cholesterol issues in the early stages.“Early detection can lead to prevention of developing diabetes and heart disease," said Legro, who wasn't involved with the new study. "Patients are more likely to change their lifestyle when they know they have a related abnormality.”
Legro told Reuters Health by email that follow up tests are vital to monitor how these issues may change and if they are improving with treatment.
Dhesi said it's important for PCOS patients to talk to their doctors about possible health risks and monitoring for them. “It is important for patients with PCOS and their health care providers to discuss the common metabolic abnormalities associated with PCOS . . . and work towards a common goal to improve their health for the future,” Dhesi told Reuters Health by email.
