Associate Editor for Contemporary OB/GYN
A session held at the American College of Obstetricians and Gynecologists’s (ACOG) 2021 Annual Meeting highlighted the signs and obstacles when treating women and teens for PCOS.
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On the second day of the ACOG Conference, Saturday, May 1, Rashmi Kudesia, MD, MSc, led a presentation on caring for teens and women with polycystic ovarian syndrome (PCOS). Kudesia is a board-certified reproductive endocrinologist and infertility specialist, ob/gyn and lifestyle medicine specialist. She also is director of Patient Education at CCRM Houston, an all-inclusive fertility treatment center in Texas.
PCOS is incredibly common and amplifies health and lifestyle choices of women and teens. In general, Kudesia recommends avoiding over- and under-diagnosis. Ob/gyns should work with the patient to craft a personalized care plan prioritizing the most relevant symptoms affecting the patient’s health and quality of life. She also highlights the importance of optimizing reproductive planning, fertility, and pregnancy outcomes.
Does it matter what type of PCOS? Kudesia doesn’t think so. “I really counsel my patients to try and not get caught up in what type of PCOS they have, but more so how it’s impacting them at any given time,” she said.
Diagnosis should be based off of the Rotterdam criteria, needing 2 of the 3 criteria to confirm: oligo- and/or anovulation; clinical and/or biochemical signs of hyperandrogenism; and polycystic ovaries. Common pitfalls of diagnosis are labeling an adolescent too early, and yet, failing to identify a child who has multiple risk factors. Within the first 8 years after menarche, presentation is not clear enough to where you can definitively say that PCOS is the issue. “The management of that is to inform the adolescent and any caregivers that she may be ‘at-risk’ for PCOS. The management of that is focused on lifestyle and ensuring that there is a regular withdrawal bleed,” Kudesia said.
Her presentation included a scope of the problem, listing the barriers to achieving optimal health such as the health care system itself; dietary advice, food supply chains and food deserts; safe spaces for exercise and limited exercise in schools; environmental exposures and lack of regulations; and also, a general lack of focus on a healthy lifestyle.
Kudesia concluded that the comprehensive management of PCOS requires a patient-centered approach and significant time dedicated to thorough education and counseling. Ob/gyns must also remain up to date on the newest advances in literature and a network of referrals and local resources. She also believes that improvement in health of the PCOS woman in pregnancy could help prevent disease in the next generation.