Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women of reproductive age. PCOS is associated with future type 2 diabetes/cardiovascular disease. Accurate diagnosis is important for early preventative interventions. However, it can take >2 years and contact with 3 or more health professionals before PCOS is diagnosed. We aimed to determine patterns of biochemical investigations performed for PCOS following initial consultation and assess their influence on subsequent radiological investigations.
Methods: Using a hospital radiology database between 2010 and 2015 to identify the study population, data was collected on biochemistry investigations performed within the 2-year period before imaging.
Results: Out of 206 women who underwent pelvic ultrasound scan (USS) and biochemical investigations, a large number of combinations (n=47) of biochemical investigations were requested at initial consultation before USS. The number of tests performed prior to USS varied from a single test to the full panel of seven tests. There was an inverse relation between the number of biochemistry tests at initial venepuncture episode and time to scan. Those who had <3 tests had significantly longer time from first request to pelvic USS (median time 70 days) than those with 37 tests (median time40 days; P=0.002, HR=1.6; 95% CI 1.22.2). FSH and LH were in the top 5 most common biochemical test panel in 53% of study population. Women with LH:FSH ratios >2 or testosterone levels >2.5 nmol/l were more likely to have PCO confirmed on USS (P<0.02), compared to women with lower ratios or levels. Serum testosterone levels were higher in PCOS women.
Conclusion: We have not found any identifiable pattern to biochemical investigations requested as part of the initial diagnostic evaluation for PCOS. Standardization of the initial biochemical panel of analytes for PCOS workup has the potential to improve efficiency and diagnostic yield with consequent patient benefit.