Trends in Diagnosis and Treatment of Polycystic Ovarian Syndrome by Specialty

OBJECTIVE: To identify trends in the diagnostic work up of polycystic ovarian syndrome (PCOS) performed by specialists in general medicine, endocrinology, and gynecology. STUDY DESIGN: Retrospective electronic Mart review of adolescents and young women whose workup for PCOS was. initiated by specialists in endocrinology, general medicine, or gynecology. RESULTS: Of 530 charts reviewed, 84 patients qualified for inclusion. Approximately two-thirds of patients seen by generalists and endocrinologists had lipid testing done; no gynecologist in this study ordered lipid tests. Cortisol levels and markers of congenital adrenal hyperplasia were more often ordered for patients seen by endocrinologists than for those seen by generalists or gynecologists. There was no significant difference among specialties in the use of diagnostic criteria for PCOS, including menstrual irregularity, hyperandrogenism, ovarian imaging, or exclusion of other etiologies. Women seen by endocrinologists tended to be prescribed metformin more often; however, there was no significant difference in the use of hormonal contraceptives, pioglitazone, and spironolactone among specialties. CONCLUSION: Across 3 clinical practice specialties commonly evaluating menstrual irregularity and/or hirsutism in young women, patients were consistently diagnosed with PCOS based on appropriate, clinically accepted criteria. However, no patients seen by gynecologists received lipid testing, which is considered an important screening study for cardiovascular disease risk in this population.