Objective: PCOS affects approximately 10% of women of reproductive age. We have audited the management of women attending the multidisciplinary PCOS clinic at the Royal Berkshire Hospital which was set up in September 2002.
Methods: Data on women attending the PCOS clinic at the Royal Berkshire Hospital between September 2002 and September 2004 were analysed. Points investigated were: baseline characteristics, adequacy of investigations and efficacy of treatment. Patient satisfaction was also assessed using a questionnaire handed out at 6 consecutive clinics.
Results: 127 women with PCOS, median age of 30 years, were seen in the clinic. The main presenting complaints were weight gain, hirsutism and oligomenorrhoea. Median BMI was 32 kilograms per metre2 and median Ferriman Gallwey (F-G) score was 11. Ovarian ultrasound was performed in 96% of women and serum testosterone measured in 76%.
Seventy patients were offered Metformin but 12 (17%) discontinued because of side effects. The median weight loss over 8 months in women continuing Metformin was 8kg, which was significantly more than those not on Metformin (p<0.0001). Menstrual cyclicity improved from a median of 20 weeks to 5 weeks (p<0.001). Of 17 women on Metformin seeking fertility 8 had successful pregnancies. Metformin therapy was associated with some improvement in hirsutism in 50% of women but was least effective in women with high F-G scores.
Twenty-three women were treated with Spironolactone for hirsutism. Eighty five percent reported an improvement in hirsutism, with the median F-G score falling from 19 to 11 in 8 months.
Sixty-two of the 63 women who completed the patient satisfaction questionnaire found the dedicated clinic very useful and were happy with the results.
Conclusions: A 'one-stop' multidisciplinary PCOS clinic improves patient satisfaction. Metformin therapy improves weight loss, menstrual cyclicity and fertility in women with PCOS. However, Spironolactone is more effective in managing hirsutism.