Future Implications of Using Registered Dietitians in Multidisciplinary Polycystic Ovary Syndrome Treatment

Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder in females with insulin resistance playing a key role in pathogenesis. The objective of this study was to investigate current trends and future implications of multidisciplinary PCOS clinics with inclusion of dietitians. A two-phase, formative investigation on practitioners was conducted through an anonymous survey followed by focus groups. Survey respondents included 261 health care providers from around the world; the majority (59%) representing multidisciplinary teams. Focus group participants included four dietitians, three physicians, a health psychologist and a licensed nutritionist. Primary barriers for future multidisciplinary clinics included: money/resources, insurance reimbursement, and difference of opinions. Potential advantages included: more comprehensive and integrated care, greater convenience/efficiency, and better long-term outcomes. A majority of respondents (89%) stated that dietitians should be ‘involved’ or ‘highly involved’ in treatment. The greatest challenges for dietitians include insurance, limited disease knowledge, and lack of referrals. Most providers agreed that multidisciplinary clinics would lead to a better prognosis. A greater emphasis needs to be placed on educating professionals on the importance of nutrition counseling. Access to educated dietitians is likely the best way to ensure that PCOS patients have access to lifestyle interventions.

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Understanding and supporting women with polycystic ovary syndrome: a qualitative study in an ethnically diverse UK sample

Endocrine Connections ◽

10.1530/ec-17-0053 ◽

2017 ◽

Vol 6 (5) ◽

pp. 323-330 ◽

Cited By ~ 8

Author(s):

Michelle Hadjiconstantinou ◽

Hamidreza Mani ◽

Naina Patel ◽

Miles Levy ◽

Melanie Davies ◽

...

Keyword(s):

Psychological Distress ◽

Polycystic Ovary Syndrome ◽

Health Care Providers ◽

Polycystic Ovary ◽

Ethnically Diverse ◽

Comparative Approach ◽

Care Providers ◽

Structured Interviews ◽

Ovary Syndrome ◽

Group Education

Objective Polycystic ovary syndrome (PCOS) is a lifelong condition. Its symptoms have been linked with psychological consequences, but less attention has been given to the daily implications of living with PCOS. We aimed to explore women’s experiences living with PCOS, and the potential acceptability of group education sessions for this target group. Methods Women with PCOS were recruited from an ethnically diverse UK community. Twelve semi-structured interviews were conducted. Analysis was underpinned by the constant comparative approach and involved the identification and exploration of key themes. Results Participants reported a range of symptoms linked with PCOS, including problems relating to menstruation and weight difficulties. Hirsutism was reported as the most distressing symptom. Emergent themes included perceptions about symptoms and delays in receiving a diagnosis; psychological distress; practical implications of living with the condition; coping with PCOS and perceived support needs. Some findings were specific to cultural backgrounds. Participants were supportive of the idea of group education for women with PCOS and suggested a need to provide education within the community and health care providers. Discussion Women with PCOS experience high psychological distress and difficulties with coping with their condition. Suggested strategies to reduce the negative psychological impact include education at various levels.

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Comparative Success of Recruitment Strategies for an Exercise Intervention Trial Among Women With Polycystic Ovary Syndrome: Observational Study

Journal of Medical Internet Research ◽

10.2196/25208 ◽

2021 ◽

Vol 23 (3) ◽

pp. e25208

Author(s):

Jamie L Benham ◽

Jane E Booth ◽

Christine M Friedenreich ◽

Doreen M Rabi ◽

Ronald J Sigal

Keyword(s):

Polycystic Ovary Syndrome ◽

Health Care Providers ◽

Exercise Intervention ◽

Polycystic Ovary ◽

Recruitment Strategy ◽

Recruitment Strategies ◽

Care Providers ◽

Ovary Syndrome ◽

Traditional Media ◽

Time Investment

Background Effective and efficient participant recruitment is a key determinant of the success of a research program. Previously reported recruitment strategies have displayed variable success rates in studies on women with polycystic ovary syndrome (PCOS). Objective This study aimed to evaluate the effectiveness and cost per participant of the recruitment strategies that we used in a prospective randomized controlled trial to examine the effects of exercise training among inactive women with PCOS, who are aged 18-40 years. Methods The 4 recruitment methods we used were as follows: (1) referral by health care providers or by word of mouth, (2) media (eg, local newspaper stories and radio interviews), (3) Facebook advertisements, and (4) unpaid advertisements including posters and websites. The proportions of potential, eligible, and enrolled participants recruited with each method were determined and compared using tests of proportion. The time investment and cost per participant enrolled were calculated for each recruitment strategy. Results Of 200 potential participants screened, 98 (49%) were recruited from unpaid advertisements (posters and websites), 70 (35%) from Facebook advertisements, 16 (8%) by referral, and 16 (8%) from traditional media (newspaper and radio). Every potential participant was recruited from separate means (ie, no participant was approached through more than one recruitment method). A total of 109 (54.5%) women were deemed eligible for participation in the trial, and 60 (30.0%) were enrolled. The proportion of potential participants who completed the trial was higher for those recruited from traditional media than from Facebook advertisements (n=7/16, 44% vs n=13/70, 19%, respectively; P=.03) or unpaid advertisements (n=7/16, 44% vs n=13/98, 13%, respectively; P=.002). The cost per participant was Can $18.21 (US $14.46) for Facebook advertisements and Can $43.88 (US $34.85) for unpaid advertisements. There were no direct trial costs for referrals or traditional media. Conclusions For this trial, each method was important for recruiting inactive women with PCOS because no participant reported learning about the trial through more than one method. Unpaid advertisements and Facebook advertisements helped recruit the largest number of participants in the trial, the former resulting in a higher cost per participant than the latter. Trial Registration ClinicalTrials.gov NCT03362918; https://clinicaltrials.gov/ct2/show/NCT03362918

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Measures of Patient Dissatisfaction With Health Care in Polycystic Ovary Syndrome: Retrospective Analysis (Preprint)

10.2196/preprints.16541 ◽

2019 ◽

Author(s):

Luis R Hoyos ◽

Manesha Putra ◽

Abigail A Armstrong ◽

Connie Y Cheng ◽

Carrie K Riestenberg ◽

...

Keyword(s):

United States ◽

Health Care ◽

Polycystic Ovary Syndrome ◽

Health Care Providers ◽

Polycystic Ovary ◽

The Internet ◽

Care Providers ◽

Ovary Syndrome ◽

Patient Dissatisfaction ◽

The Web

BACKGROUND Polycystic ovary syndrome (PCOS) is a common reproductive and metabolic disorder in women; however, many clinicians may not be well versed in scientific advances that aid understanding of the associated reproductive, metabolic, and psychological abnormalities. Women with PCOS are dissatisfied with health care providers, the diagnostic process, and the initial treatment of PCOS and seek information through alternative sources. This has affected the patient-physician relationship by allowing medical information acquired through the internet, whether correct or not, to become accessible to patients and reshape their health care perspective. Patient dissatisfaction with health care providers regarding PCOS raises questions about the responsibilities of academic institutions to adequately train and maintain the competence of clinicians and government agencies to sufficiently support scientific investigation in this field. OBJECTIVE The primary aim was to examine internet searching behaviors of the public regarding PCOS vs another highly prevalent gynecologic disorder. The secondary aim was to explore satisfaction with health care among patients with PCOS and their internet use. The tertiary aim was to examine medical education in reproductive endocrinology and infertility (REI) during obstetrics and gynecology (Ob/Gyn) residency as a proxy for physician knowledge in this field. METHODS Google search trends and StoryBase quantified monthly Google absolute search volumes for search terms related to PCOS and fibroids (January 2004 to December 2017; United States). The reproductive disorder, fibroids, was selected as a comparison group because of its high prevalence among women. Between female groups, monthly absolute search volumes and their trends were compared. A Web-based questionnaire (June 2015 to March 2018) explored health care experiences and the internet use of women with PCOS. REI rotation information during Ob/Gyn residency in the United States was obtained from the Association of Professors of Gynecology and Obstetrics website. RESULTS For PCOS (R=0.89; P<.01), but not fibroids (R=0.09; P=.25), monthly absolute search volumes increased significantly. PCOS-related monthly absolute search volumes (mean 384,423 searches, SD 88,756) were significantly greater than fibroid-related monthly absolute search volumes (mean 348,502 searches, SD 37,317; P<.05). PCOS was diagnosed by an Ob/Gyn in 60.9% (462/759) of patients, and 57.3% (435/759) of patients were dissatisfied with overall care. Among patients with PCOS, 98.2% (716/729) searched for PCOS on the Web but only 18.8% (143/729) of patients joined an online PCOS support group or forum. On average, Ob/Gyn residencies dedicated only 4% (2/43) of total block time to REI, whereas 5.5% (11/200) of such residencies did not offer any REI rotations. CONCLUSIONS Over time, PCOS has been increasingly searched on the Web compared with another highly prevalent gynecologic disorder. Patients with PCOS are dissatisfied with their health care providers, who would benefit from an improved understanding of PCOS during Ob/Gyn residency training.

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Women with Polycystic Ovary Syndrome: A Marginalized Population in the United States

Health & Social Work ◽

10.1093/hsw/hlz033 ◽

2020 ◽

Vol 45 (1) ◽

pp. 40-46 ◽

Cited By ~ 1

Author(s):

Ninive Sanchez

Keyword(s):

United States ◽

Polycystic Ovary Syndrome ◽

Health Care Providers ◽

Polycystic Ovary ◽

Public Health Problem ◽

The United States ◽

Standards Of Care ◽

Major Public Health Problem ◽

Care Providers ◽

Ovary Syndrome

Abstract The National Institutes of Health has identified polycystic ovary syndrome (PCOS) as a major public health problem for women in the United States and recommends establishing multidisciplinary programs to improve the awareness of the public and health care providers regarding management for women with PCOS. This article argues that individuals with PCOS are marginalized due to the syndrome’s misleading name; its underrepresentation in research; lack of culturally and gender-sensitive standards of care; debates about the contraceptive mandate; and stigmatization due to symptoms that do not conform to dominant social constructs of beauty, femininity, and womanhood. The article directs readers to key publications on the assessment and treatment of patients with PCOS, discusses a case study that illustrates the role of a social worker in treating an adolescent with PCOS as part of a multidisciplinary team, and emphasizes the importance of integrating behavioral health in the treatment of patients with PCOS.

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Measures of Patient Dissatisfaction With Health Care in Polycystic Ovary Syndrome: Retrospective Analysis

Journal of Medical Internet Research ◽

10.2196/16541 ◽

2020 ◽

Vol 22 (4) ◽

pp. e16541 ◽

Cited By ~ 1

Author(s):

Luis R Hoyos ◽

Manesha Putra ◽

Abigail A Armstrong ◽

Connie Y Cheng ◽

Carrie K Riestenberg ◽

...

Keyword(s):

United States ◽

Health Care ◽

Polycystic Ovary Syndrome ◽

Health Care Providers ◽

Polycystic Ovary ◽

The Internet ◽

Care Providers ◽

Ovary Syndrome ◽

Patient Dissatisfaction ◽

The Web

Background Polycystic ovary syndrome (PCOS) is a common reproductive and metabolic disorder in women; however, many clinicians may not be well versed in scientific advances that aid understanding of the associated reproductive, metabolic, and psychological abnormalities. Women with PCOS are dissatisfied with health care providers, the diagnostic process, and the initial treatment of PCOS and seek information through alternative sources. This has affected the patient-physician relationship by allowing medical information acquired through the internet, whether correct or not, to become accessible to patients and reshape their health care perspective. Patient dissatisfaction with health care providers regarding PCOS raises questions about the responsibilities of academic institutions to adequately train and maintain the competence of clinicians and government agencies to sufficiently support scientific investigation in this field. Objective The primary aim was to examine internet searching behaviors of the public regarding PCOS vs another highly prevalent gynecologic disorder. The secondary aim was to explore satisfaction with health care among patients with PCOS and their internet use. The tertiary aim was to examine medical education in reproductive endocrinology and infertility (REI) during obstetrics and gynecology (Ob/Gyn) residency as a proxy for physician knowledge in this field. Methods Google search trends and StoryBase quantified monthly Google absolute search volumes for search terms related to PCOS and fibroids (January 2004 to December 2017; United States). The reproductive disorder, fibroids, was selected as a comparison group because of its high prevalence among women. Between female groups, monthly absolute search volumes and their trends were compared. A Web-based questionnaire (June 2015 to March 2018) explored health care experiences and the internet use of women with PCOS. REI rotation information during Ob/Gyn residency in the United States was obtained from the Association of Professors of Gynecology and Obstetrics website. Results For PCOS (R=0.89; P<.01), but not fibroids (R=0.09; P=.25), monthly absolute search volumes increased significantly. PCOS-related monthly absolute search volumes (mean 384,423 searches, SD 88,756) were significantly greater than fibroid-related monthly absolute search volumes (mean 348,502 searches, SD 37,317; P<.05). PCOS was diagnosed by an Ob/Gyn in 60.9% (462/759) of patients, and 57.3% (435/759) of patients were dissatisfied with overall care. Among patients with PCOS, 98.2% (716/729) searched for PCOS on the Web but only 18.8% (143/729) of patients joined an online PCOS support group or forum. On average, Ob/Gyn residencies dedicated only 4% (2/43) of total block time to REI, whereas 5.5% (11/200) of such residencies did not offer any REI rotations. Conclusions Over time, PCOS has been increasingly searched on the Web compared with another highly prevalent gynecologic disorder. Patients with PCOS are dissatisfied with their health care providers, who would benefit from an improved understanding of PCOS during Ob/Gyn residency training.

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Polycystic Ovary Syndrome

Journal of Pharmacy Practice ◽

10.1177/0897190010384632 ◽

2010 ◽

Vol 24 (1) ◽

pp. 94-101 ◽

Cited By ~ 3

Author(s):

Kristin Nadine Whitaker

Keyword(s):

Type 2 Diabetes ◽

Metabolic Syndrome ◽

Polycystic Ovary Syndrome ◽

Health Care Providers ◽

Polycystic Ovary ◽

Signs And Symptoms ◽

Reproductive Age ◽

Care Providers ◽

Ovary Syndrome

Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. It affects 6% to 7% of the population and is characterized by hyperandrogenism and ovarian dysfunction. Women with the disorder often present with insulin resistance and obesity, making it importance for health care providers to monitor closely for signs and symptoms of metabolic syndrome and type 2 diabetes. Treatments are targeted toward improving insulin tolerance, reducing signs and symptoms of hyperandrogenism (hirsutism, anovulation, etc), restoring normal menstrual cycle function, and restoring fertility. Major treatment should include weight management through diet and exercise, regardless of body mass index and might include concurrent drug therapy. It is important that pharmacists understand the underlying pathophysiology of the disease and the available treatments, in addition to the importance of reducing risk of metabolic syndrome/type 2 diabetes, and cardiovascular disease in these patients.

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Comparative Success of Recruitment Strategies for an Exercise Intervention Trial Among Women With Polycystic Ovary Syndrome: Observational Study (Preprint)

10.2196/preprints.25208 ◽

2020 ◽

Author(s):

Jamie L Benham ◽

Jane E Booth ◽

Christine M Friedenreich ◽

Doreen M Rabi ◽

Ronald J Sigal

Keyword(s):

Polycystic Ovary Syndrome ◽

Health Care Providers ◽

Exercise Intervention ◽

Polycystic Ovary ◽

Recruitment Strategy ◽

Recruitment Strategies ◽

Care Providers ◽

Ovary Syndrome ◽

Traditional Media ◽

Time Investment

BACKGROUND Effective and efficient participant recruitment is a key determinant of the success of a research program. Previously reported recruitment strategies have displayed variable success rates in studies on women with polycystic ovary syndrome (PCOS). OBJECTIVE This study aimed to evaluate the effectiveness and cost per participant of the recruitment strategies that we used in a prospective randomized controlled trial to examine the effects of exercise training among inactive women with PCOS, who are aged 18-40 years. METHODS The 4 recruitment methods we used were as follows: (1) referral by health care providers or by word of mouth, (2) media (eg, local newspaper stories and radio interviews), (3) Facebook advertisements, and (4) unpaid advertisements including posters and websites. The proportions of potential, eligible, and enrolled participants recruited with each method were determined and compared using tests of proportion. The time investment and cost per participant enrolled were calculated for each recruitment strategy. RESULTS Of 200 potential participants screened, 98 (49%) were recruited from unpaid advertisements (posters and websites), 70 (35%) from Facebook advertisements, 16 (8%) by referral, and 16 (8%) from traditional media (newspaper and radio). Every potential participant was recruited from separate means (ie, no participant was approached through more than one recruitment method). A total of 109 (54.5%) women were deemed eligible for participation in the trial, and 60 (30.0%) were enrolled. The proportion of potential participants who completed the trial was higher for those recruited from traditional media than from Facebook advertisements (n=7/16, 44% vs n=13/70, 19%, respectively; P=.03) or unpaid advertisements (n=7/16, 44% vs n=13/98, 13%, respectively; P=.002). The cost per participant was Can $18.21 for Facebook advertisements and Can $43.88 for unpaid advertisements. There were no direct trial costs for referrals or traditional media. CONCLUSIONS For this trial, each method was important for recruiting inactive women with PCOS because no participant reported learning about the trial through more than one method. Unpaid advertisements and Facebook advertisements helped recruit the largest number of participants in the trial, the former resulting in a higher cost per participant than the latter. CLINICALTRIAL ClinicalTrials.gov NCT03362918; https://clinicaltrials.gov/ct2/show/NCT03362918

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Impact of rs2414096 polymorphism of CYP19 gene on susceptibility of polycystic ovary syndrome and hyperandrogenism in Kashmiri women

Scientific Reports ◽

10.1038/s41598-021-92265-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sairish Ashraf ◽

Shayaq Ul Abeer Rasool ◽

Mudasar Nabi ◽

Mohd Ashraf Ganie ◽

Shariq R. Masoodi ◽

...

Keyword(s):

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Clinical Manifestations ◽

Additive Model ◽

Genotypic Frequency ◽

Ovary Syndrome ◽

Significant Difference ◽

Cyp19 Gene ◽

Reproductive Endocrine ◽

The Impact

AbstractPolycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder in pre-menopausal women having complex pathophysiology. Several candidate genes have been shown to have association with PCOS. CYP19 gene encodes a key steroidogenic enzyme involved in conversion of androgens into estrogens. Previous studies have reported contradictory results with regard to association of SNP rs2414096 in CYP19 gene with PCOS and hyperandrogenism in different ethnic populations. Present study was aimed to investigate the impact of SNP rs2414096 polymorphism of CYP19 gene on susceptibility of PCOS and hyperandrogenism in Kashmiri women. Further we also studied the genotypic-phenotypic association for various clinical and biochemical parameters of this polymorphism. Case control study. 394 PCOS cases diagnosed on the basis of Rotterdam criteria and age matched 306 healthy women. We found a significant differences in genotypic frequency (χ2 = 18.91, p < 0.05) as well as allele frequency (OR 0.63, CI 0.51–0.78, χ2 = 17.66, p < 0.05) between PCOS women and controls. The genotype–phenotype correlation analysis showed a significant difference in FG score (p = 0.047) and alopecia (p = 0.045) between the three genotypes. Also, the androgen excess markers like DHEAS (p < 0.001), Androstenedione (p < 0.001), Testosterone (p < 0.001) and FAI (p = 0.005) were significantly elevated in GG genotype and showed a significant difference in additive model in PCOS women. rs2414096 polymorphism of CYP19 gene is associated with the risk of PCOS as well as with clinical and biochemical markers of hyperandrogenism, hence suggesting its role in clinical manifestations of PCOS in Kashmiri women.

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Depression in patients with polycystic ovary syndrome: a descriptive two-phase (prospective) study

Pharmateca ◽

10.18565/pharmateca.2019.6.69-73 ◽

2019 ◽

Vol 6_2019 ◽

pp. 68-72

Author(s):

N.A. Ilina Ilina ◽

T.V. Dovzhenko Dovzhenko ◽

E.E. Grodnitskaya Grodnitskaya ◽

◽

Keyword(s):

Polycystic Ovary Syndrome ◽

Prospective Study ◽

Polycystic Ovary ◽

Ovary Syndrome ◽

Two Phase

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The Role of the Brain in the Pathogenesis and Physiology of Polycystic Ovary Syndrome (PCOS)

Medical Sciences ◽

10.3390/medsci7080084 ◽

2019 ◽

Vol 7 (8) ◽

pp. 84 ◽

Cited By ~ 3

Author(s):

Coutinho ◽

Kauffman

Keyword(s):

Animal Models ◽

Polycystic Ovary Syndrome ◽

Neural Circuit ◽

Polycystic Ovary ◽

Pulse Frequency ◽

Reproductive Age ◽

Neuron Activity ◽

Ovary Syndrome ◽

Gnrh Neurons ◽

Reproductive Endocrine

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder, affecting at least 10% of women of reproductive age. PCOS is typically characterized by the presence of at least two of the three cardinal features of hyperandrogenemia (high circulating androgen levels), oligo- or anovulation, and cystic ovaries. Hyperandrogenemia increases the severity of the condition and is driven by increased luteinizing hormone (LH) pulse secretion from the pituitary. Indeed, PCOS women display both elevated mean LH levels, as well as an elevated frequency of LH pulsatile secretion. The abnormally high LH pulse frequency, reflective of a hyperactive gonadotropin-releasing hormone (GnRH) neural circuit, suggests a neuroendocrine basis to either the etiology or phenotype of PCOS. Several studies in preclinical animal models of PCOS have demonstrated alterations in GnRH neurons and their upstream afferent neuronal circuits. Some rodent PCOS models have demonstrated an increase in GnRH neuron activity that correlates with an increase in stimulatory GABAergic innervation and postsynaptic currents onto GnRH neurons. Additional studies have identified robust increases in hypothalamic levels of kisspeptin, another potent stimulator of GnRH neurons. This review outlines the different brain and neuroendocrine changes in the reproductive axis observed in PCOS animal models, discusses how they might contribute to either the etiology or adult phenotype of PCOS, and considers parallel findings in PCOS women.

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