The Indian Practitioner

Beena Joshi ¹, Gazala Hasan ², Gulrez Tyebkhan ³, Shobha Udipi ⁴, Anushree Patil ⁵, Duru Shah ⁶, Madhuri Patil ⁷, Roda Dalal ⁸, Rama Vaidya ⁹

Affiliations
1 Scientist F, Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, IN
2 Senior Research Fellow, Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, IN
3 Hon Consultant Dermatologist, Medical Research Centre-Kasturba Health Society; Hon Dermatologist, Saifee Hospital, Mumbai, IN
4 Hon Director Integrative Nutrition and Ayurceuticals, Medical Research Centre-Kasturba Health Society, Mumbai, IN
5 Scientist D, Department of Clinical Research, ICMR- National Institute for Research in Reproductive Health, Mumbai, IN
6 President, PCOS Society, India. Scientific Director, Gynaecworld Assisted Fertility Center, Mumbai, IN
7 Vice-President, PCOS Society, India; Clinical Director, Dr. Patil’s Fertility and Endoscopy Clinic, Bengaluru, IN
8 Hon Editorial Consultant and Communications Associate, Medical Research Centre-Kasturba Health Society, Mumbai, IN
9 Director, Division of Endocrine and Metabolic Disorders, Medical Research Centre-Kasturba Health Society, Mumbai, IN

Abstract

Background: Polycystic Ovary Syndrome (PCOS) diagnosis is very complex and due to overlapping presentation of symptoms, women with PCOS may approach various practitioners, who might be using varied definitions to diagnose and manage PCOS.

Objectives: To assess knowledge about PCOS diagnosis and management by Dermatologists, Gynecologists, Endocrinologists and Family Physicians (FPs).

Methods: This cross-sectional study was done among 529 health care providers (HCPs) practicing in Mumbai metropolitan region using a convenient sample. A self-administered pretested questionnaire was filled by the HCPs after obtaining informed consent. Pearson’s Chi-square test and Analysis of Variance (ANOVA) was used to study the differences within each group.

Results: All HCPs reported that women with PCOS consulted them with a varied spectrum of symptoms. Among FPs, Allopaths had better knowledge about diagnosis and Homeopaths were more confident about PCOS management. Among Specialists, Endocrinologists were more stringent in diagnosing cases as per defined criteria, along with screening and comprehensive management of the metabolic syndrome. Although the need for multidisciplinary management was perceived, in practice holistic management was not common.

Conclusions: This study reveals the need for training and disseminating algorithms for comprehensive PCOS management across disciplines. It highlights women’s preferences in seeking health care for symptom complex of PCOS. These findings would help health policymakers to develop community-based awareness modules and India-specific management guidelines for early screening and a continuum of care for PCOS patients.

Keywords

Polycystic ovary syndrome, healthcare providers, knowledge assessment, practice, management

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Gulrez Tyebkhan ¹, Beena Joshi ², Rama Vaidya ³

Affiliations
1 Hon Consultant Dermatologist, Medical Research Centre- Kasturba Health Society, Mumbai, India. Hon Dermatologist, Saifee Hospital, Mumbai, IN
2 Scientist F, Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, IN
3 Director, Division of Endocrine and Metabolic Disorders,Medical Research Centre- Kasturba Health Society, Mumbai, IN

Abstract

Polycystic Ovary Syndrome (PCOS), a common reproductive-endocrine-metabolic disorder of women with its galloping prevalence is reaching epidemic proportions today in India and abroad. Women suffering from PCOS have a wide spectrum of clinical manifestations like irregular menstrual cycles, infertility, hirsutism, acne and vulnerability for obesity. Besides these women are at a risk for concurrently manifesting obesity and prediabetes or subsequent development of type 2 diabetes mellitus and consequent cardiovascular diseases. Some of the manifestations have caused stigmatization and social isolation of women with PCOS contributing to its adverse psycho-social impact. This multiplicity of diverse manifestations makes it difficult for the patients to choose a specialist. As a consequence, there is often a fragmented attention to PCOS from diverse specialties like dermatology, gynecology, diabetology and psychiatrist. Additionally, the less known and poorly understood etiology of PCOS have also posed a challenge for medical science for committed research, education and organized services. This is more so due to the compartmentalization and divergence into super specialization in modern medical and biomedical sciences. Recognizing PCOS as a condition of great public health issue in India, a group of committed clinical and basic scientists from four major institutes of Mumbai formed, ABHIYAAN PCOS, a consortium for a co-operative endeavor in addressing the multiple aspects that concern women with PCOS. In the present article, we have covered the ground reality of the PCOS in India, the need to develop India-specific guidelines in-view of the pluralistic healthcare and the current efforts in the domain of PCOS by both private and public health-sectors.

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