Women’s experiences of diagnosis and management of polycystic ovary syndrome: a mixed-methods study in general practice

Our interest in gynaecology attracted us to the study by Hillman et al. However, certain aspects need addressing. Firstly, we acknowledge that participants of the study were mainly White and British Asian. We believe this isn’t representative for patients with PCOS as it is more prevalent amongst women of BAME backgrounds.¹. Therefore, splitting British Asian into subdivisions (such as Indian, Pakistani, Sri Lankan) would allow a better analysis of the variations existing between them; for example, dietary differences, cultural implications, etc. Having this information to hand will then enable addressing issues around mental health and fertility to be tackled with more targeted precision. We also understand that PCOS has a higher prevalence in patients with lower socio-economic backgrounds² and therefore to widen the participant pool, surveys and interviews could be delivered in different languages and formats.

An important aspect to consider is the criteria by which a diagnosis of PCOS was made. Many participants did not have a definitive diagnosis as recommended by NICE³ due to them self-diagnosing or having had a family member diagnose them implicating potential false-positive patients.

Moreover, qualitative data analysed was based on patient recall. With a range as large as 10 years for a diagnosis to be made, there would be profound difficulties in recalling information given by doctors. We agree that achieving triangulation using quantitative data was impressive, however this could be further improved by utilising data from GP surgeries to include official documentation of the diagnosis and management.

To improve the study further, interviews/surveys could be done with the GPs who had diagnosed the patients. This would allow a comparison to be made about themes that arose as well understand how confident GP’s felt when delivering PCOS management.

References
1. Wolf WM, Wattick RA, Kinkade ON et al. Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity. Int J Environ Res Public Health 2018; 15(11):2589. 
2. Merkin SS, Azziz R, Seeman T et al. Socioeconomic status and polycystic ovary syndrome. J Women’s Health 2011; (3): 413-419. 
3. NICE CKS.  Polycystic ovary syndrome.  Available from: https://cks.nice.org.uk/polycystic-ovary-syndrome#!topicSummary [accessed 14 May 2020].