Overdiagnosis of Polycystic Ovary Syndrome May Be Leading To Unnecessary Treatment: BMJ

New research suggests that many women are being misdiagnosed with polycystic ovary syndrome, causing unnecessary treatment and potentially harming their well being. 

Polycystic ovary syndrome (PCOS) is the most commonly diagnosed endocrine disorder among reproductive aged women. The diagnosis was first established in 1930, but was later expanded by the Rotterdam consensus to include other criteria in 2003.

Authors of a new analysis, published this month in the medical journal The BMJ, indicate that the expanded criteria has increased the prevalence of PCOS among young women, causing more diagnoses, and as a result more harm to women.

PCOS is when a woman produces more male hormones, including testosterone, than normal. This can cause a woman to experience a wide range of symptoms, such as failing to ovulate regularly, menstrual irregularities, causing the ovaries to have many small cysts (polycystic), and have excess hair and acne.

The condition is linked to a higher than normal risk of infertility, diabetes, heart disease, and high blood pressure.

There is no known cure for PCOS, and it typically leads to a lifetime of treatment and medication. Treatment can range from diet and lifestyle changes, to fertility medications, birth control to help with menstrual and hair growth irregularities, as well as other hormone therapy.

The new analysis indicates the change to the PCOS diagnosis under the Rotterdam criteria increased how often women are being told they have the condition.

Under the old criteria, about 4% to 6% of women had PCOS. Using the new criteria, more than 21% of women are diagnosed with the condition.

The Rotterdam consensus added the “presence of polycystic ovaries” as a key part of diagnosis criteria. This is problematic because many women without PCOS also have polycystic ovaries.

In fact, polycystic ovaries are found in 62% to 84% of women in the general population ages 18 to 30 and in 7% of women ages 41 to 45. However, with the new criteria, many women without PCOS would be incorrectly diagnosed with the condition.

The problem with over-diagnosis of PCOS is it leads to long term medication use, which can affect hormones and physical health.

It can also lead to psychological impacts from labeling a healthy women with a condition that can be difficult to manage. Women with PCOS have higher rates of depression, anxiety, poor self esteem, negative body image, disordered eating, and decreased sexual satisfaction. Researchers fear over-diagnosis may lead to increased prevalence of these conditions.

Researchers indicate labeling a woman with PCOS does not help treat the symptoms of the condition. Offering a diagnosis does little to help a women navigate the disease. It also doesn’t change the type or intensity of treatment. Each individual symptom can be treated separately.

To that end, study authors recommend a slower, delayed approach to PCOS diagnosis. They believe this will serve to reduce the harms from labeling a women with the condition and may help optimize benefits.