Increased odds of disordered eating in polycystic ovary syndrome: a systematic review and meta-analysis.

PURPOSE: We aimed to identify the risk of eating disorders (ED) in women with polycystic ovary syndrome (PCOS) compared to controls. METHODS: We performed a systematic review and meta-analysis of studies that included women with well-defined PCOS and controls and used validated ED screening/diagnostic tools to measure mean ED score, prevalence of abnormal ED scores, and/or prevalence of specific ED diagnoses such as bulimia nervosa and binge eating disorder. RESULTS: Eight studies, including 470 women with PCOS and 390 controls, met inclusion criteria for the systematic review. Meta-analysis of seven of those studies found that the odds of an abnormal ED score (OR 3.05; 95% CI 1.33, 6.99; four studies) and the odds of any ED diagnosis (OR 3.87; 95% CI 1.43, 10.49; four studies) were higher in women with PCOS compared to controls. CONCLUSIONS: Our study suggests that women with PCOS are at increased odds of having abnormal ED scores and specific ED diagnoses. Given the potential implications of an ED on weight management strategies, our findings support routine screening for ED in this population. LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis.

Gaps in knowledge among physicians regarding diagnostic criteria and management of polycystic ovary syndrome.

OBJECTIVE: To identify gaps in polycystic ovary syndrome (PCOS) knowledge and practice patterns among physicians in North America in response to significant dissatisfaction identified among women with PCOS regarding their diagnosis and treatment experience. DESIGN: Online survey conducted via American College of Obstetrics and Gynecology of gynecologists (ObGyn) and American Society of Reproductive Medicine of reproductive endocrinologists (REI-ObGyn) in 2015-16. SETTING: Not applicable. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Diagnostic criteria used, key features of PCOS, management practices. RESULT(S): Of the 630 surveys completed, 70.2% were ObGyn and 64.4% were females. Overall 27.7% respondents did not know which PCOS diagnostic criteria they used. In a multivariable analysis including physician type, age, gender, and number of patients with PCOS seen annually, REI-ObGyn were less likely compared with ObGyn to report not knowing which criteria they used (adjusted odds ratio, 0.08; 95% confidence interval, 0.04, 0.16). REI-ObGyn were more likely to use the Rotterdam criteria (odds ratio, 2.26; 95% confidence interval, 1.33, 3.82). The majority of respondents recognized the clinical features associated with PCOS; however, over one-third associated "cysts on ovaries" with PCOS. The majority of responders (>85%) were aware of cardiometabolic comorbidities; however, fewer ObGyn were aware of associated depression, anxiety disorders, and reduced quality of life. More REI-ObGyn recommended lifestyle changes compared with ObGyn (56.4% vs. 41.6%). CONCLUSION(S): Our large-scale PCOS survey, conducted in response to patient concerns regarding diagnosis and treatment, highlights opportunities for physician education. Focus areas include targeting knowledge of internationally accepted Rotterdam criteria and ensuring consistent care informed by evidence-based guidelines across the reproductive, metabolic, and psychological features of PCOS.

Increased risk of disordered eating in polycystic ovary syndrome.

OBJECTIVE: To determine the prevalence of eating disorders (EDs) in women with polycystic ovary syndrome (PCOS) and the effects of EDs on health-related quality of life. DESIGN: Cross-sectional study. SETTING: University practice. PATIENT(S): Women with PCOS (Rotterdam criteria; n = 148) and controls seen for routine gynecologic care (n = 106) from 2015 to 2016. INTERVENTION(S): Eating Disorder Examination-Questionnaire (EDE-Q), Night Eating Questionnaire (NEQ), Hospital Anxiety and Depression Scale, and Health-Related Quality of Life Questionnaire (PCOSQ). MAIN OUTCOME MEASURE(S): EDE-Q and NEQ scores, prevalence of bulimia nervosa (BN), binge eating disorder (BED), and night eating syndrome (NES). RESULT(S): Women with PCOS were at an increased risk for overall abnormal EDE-Q scores compared with controls (12.16% vs. 2.83%; odds ratio [OR], 4.75; 95% confidence interval [CI], 1.36, 16.58). Clinically significant elevated scores were noted for shape and weight concern. In unadjusted analysis, body mass index (OR, 1.06; 95% CI, 1.01, 1.11), elevated depression score (OR, 5.43; 95% CI, 1.85, 15.88), and elevated anxiety score (OR, 6.60; 95% CI, 2.45, 17.76) were associated with an abnormal EDE-Q global score. In the multivariable model, PCOS was associated with abnormal EDE-Q global score (adjusted OR, 4.67; 95% CI, 1.16, 18.80). Elevated EDE-Q scores inversely correlated with PCOSQ scores (r = -0.57). The prevalence of BN was 6.1%, of BED was 17.6%, and of NES was 12.9% in women with PCOS, with no differences compared with controls. CONCLUSION(S): Women with PCOS, especially those with concurrent anxiety symptoms but independent of obesity, have a significantly increased risk of abnormal EDE-Q scores. Our findings suggest the need for routine screening for ED in this population.