Primary Care Screening Tool for Polycystic Ovary Syndrome: Step One in the Battle Against Non-Communicable Disease : Indian Journal of Endocrinology and Metabolism

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Brief Communication

Primary Care Screening Tool for Polycystic Ovary Syndrome: Step One in the Battle Against Non-Communicable Disease

Kalra, S1,; Vaidya, R2; Verma, M3,4; Joshi, A5

Author Information
Indian Journal of Endocrinology and Metabolism 27(2):p 105-106, Mar–Apr 2023. | DOI: 10.4103/ijem.ijem_333_22
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Abstract

INTRODUCTION

The world is experiencing an epidemic of metabolic disease, with India facing more than its fair share of the burden.[1] Current understanding reinforces the importance of women’s health, in the reproductive phase and beyond, in preventing and mitigating chronic metabolic disease. One example of a gender-specific syndrome that can lead to multiple metabolic maladies is polycystic ovary syndrome (PCOS).[2,3] PCOS is often the first manifestation, in adolescents and young adults, of metabolic problems that may occur later in life. Early identification, timely referral and appropriate treatment can result in improved reproductive, metabolic, medical and psychological health.[4]

Clinical screening: Challenges and solutions

PCOS is a well-recognized syndrome, with established diagnostic and grading criteria.[2] The current approach needs hormonal assays and/or imaging modalities for confirmation of diagnosis. This prevents PCOS from being diagnosed at the primary healthcare level, due to logistic constraints.

A similar situation is encountered with other diseases, where confirmatory diagnostic modalities are not easily available or affordable.[5,6] One solution is to create and validate screening or prescreening tools, based upon clinical variables. These can be used to screen and identify individuals at high risk of PCOS and refer them for confirmation of diagnosis and appropriate management at a higher level of healthcare.

Screening tool for PCOS

Such an approach can be tried for PCOS as well. A clinical screening tool, based on history taking, which can be administered by paramedical staff, at primary healthcare, should be able to improve the detection rate of PCOS and facilitate its management. This tool, however, should be validated.

We propose a user-friendly primary care screening tool which can be used to identify women who need the referral for diagnosis and treatment [Table 1]. It consists of six questions, structured into three domains: menstrual/maternity, metabolic and ‘misfit masculinity’ (dermatological). We suggest that a positive answer to a question in any two domains should prompt suspicion of PCOS. The tool can be strengthened by adding pictorial gradings of menstrual flow/regularity, acanthosis nigricans, acne, and hirsutism (Ferriman–Gallwey score), which help in objective reporting.[7–10]

T1
Table 1:
Primary care prescreening tool for PCOS

Summary

The primary care screening tool for PCOS will promote awareness, screening and identification of the syndrome as well as timely addressal. This should facilitate improvement in both non-communicable disease prevention as well as maternal health.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

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      Keywords:

      Integrated care; maternal health; menstrual disorders; metabolic syndrome; obesity; PCOS; preventive health; public health

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