Polycystic ovary syndrome

Editor, – I note that many people with polycystic ovary syndrome are being prescribed long-term metformin by their general practitioner regardless of any desire to fall pregnant.

I also note that the diagnosis of this syndrome seems to be woollier than a sheep in a lambswool jumper with ugh boots. Even the polycystic part appears to be excluded in some diagnostic criteria, because polycystic ovaries seem to be a feature of chronic anovulation regardless of cause. Yet many people attract the diagnosis on this feature alone with or without being overweight.

I recall a study showing a lack of evidence for cardiovascular risk in these patients and I find that hard to integrate with their insulin resistance. Dr Joyner correctly uses this to continue to prescribe combined oral contraceptive pill to patients over 35, but this sits uncomfortably with me. Could Dr Joyner comment on the quality of this evidence?

If such a person had a BMI > 35 then I would avoid the combined oral contraceptive pill, but this practice is independent of a diagnosis of polycystic ovary syndrome.

Kevin O'Dempsey
General practitioner
Brisbane

Dr B. Joyner, the author of the article, comments:

As mentioned in my article, polycystic ovary syndrome is a heterogeneous condition. It is a syndrome based on phenotype and there is no single diagnostic criterion. The definitions used in trials may vary depending on the feature being studied. There have also been regional variations in definitions. US definitions have focused on the endocrine features, while definitions from the UK have required the demonstration of polycystic ovaries. There was further revision of the criteria for polycystic ovary syndrome at an international consensus workshop in 2003.¹ If other causes are excluded, two of the following criteria are required:

• oligo-and/or anovulation
• clinical and/or biochemical signs of hyperandrogenism
• polycystic ovaries.

The results of studies regarding the risk of cardiovascular disease in women with polycystic ovary syndrome are conflicting. Most studies have been small and retrospective. Cohorts need to be followed for a longer period of time. However, cardiovascular risk factors including hypertension, diabetes, and hypercholesterolaemia are more common in women with polycystic ovary syndrome, a syndrome that often interweaves with the metabolic syndrome.^2,3

As mentioned in my article, there is no evidence to suggest women with polycystic ovary syndrome experience more cardiovascular events while on the combined oral contraceptive pill. However, most of the studies have been small and short term. The use of the oral contraceptive pill therefore requires clinical judgement of the harms and benefits for each woman.