Background: PCOS is a common female endocrine disorder, exacerbated by obesity. International guidelines therefore suggest weight loss as first line management. This service evaluation assessed the care pathway of patients referred to Queen Elizabeth Hospital Birmingham (QEHB) with suspected PCOS. We aimed to assess the referral wait time, reason for referral, treatment offered, and weight management in clinic.
Methods: We undertook a cross-sectional study of retrospective data. We assessed a dataset of 378 clinically phenotyped women with suspected androgen excess that attended QEHB over a 5-year period. We excluded: patients without a diagnosis of PCOS (n=150), those added to the dataset before 2016 (n=168), and those with unavailable hospital records (n=11). Hence, 49 patients were included. The following data were obtained from the electronic records, coded and analysed using Microsoft Excel: age, dates of referral and clinic appointments, reason for referral, type and time of treatment initiated, and BMI at first and last clinic appointment.
Results: Most women were seen within 18 weeks, but 11% did not meet the 18-week target. The most common presenting complaints were androgen excess (80%, n=39), and oligomenorrhoea/amenorrhea (78%, n=38). For management, 37/49 outpatients were recommended oral contraceptive pills (51%), metformin (45%) or other pharmacological treatment. Of the patients with BMI data available (34/49), 56% (n=19) gained weight after their first appointment whilst 34% (n=12) lost weight. The patient with the greatest increase in BMI (9.7 kg/m2) was seen over 9 years. Moreover, for 19% (5/35) of overweight patients, weight management advice was not given at the first clinic, and for those who received this, only 40% had a reduction in BMI.
Conclusions: There is sub-optimal weight management for those patients despite weight counselling in clinic. This supports the need for a comprehensive PCOS service for patients, including contact with a dietician and regular weight follow-up.