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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.
- The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004;19:41-7.
- Wild S, Pierpoint T, McKeigue P, Jacobs H. Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Clin Endocrinol 2000;52:595-600.
- Korhonen S, Hippelainen M, Niskanen L, Vanhala M, Saarikoski S. Relationship of the metabolic syndrome and obesity to polycystic ovary syndrome: a controlled, population-based study. Am J Obstet Gynecol 2001;184:289-96.