Screening for diabetes and cardiometabolic disease in women with polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is a significant risk factor for developing type 2 diabetes and increased cardiovascular disease risk (together referred to as ‘cardiometabolic disease’, CMD). Primary prevention of CMD may be possible in women with PCOS but the diagnostic criteria for PCOS are controversial and this often hampers optimal clinical management. PCOS affects as many as 18% of women of reproductive age, and at least 70% remain undiagnosed in primary care. Screening women with PCOS for diabetes is seldom undertaken, largely through difficulties in diagnosis due to identification and management of PCOS continuing to focus on treatment of infertility and hirsutism. This article focuses on the diagnostic challenges of making the initial diagnosis of PCOS and considers how screening, detection and prevention of CMD might become routine clinical practice. It explores the unique challenges associated with PCOS and highlights the need for better evidence to justify screening and intervention. Finally, a pragmatic approach to assessing women with PCOS is suggested for use within primary care.