Approach to Diagnosis and Management of Polycystic Ovary Syndrome in Bangladesh: A Nationwide Cross-Sectional Survey of Physicians.

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder among women of reproductive age. This nationwide cross-sectional study aimed to assess physicians' diagnostic and management practices for PCOS in Bangladesh, with a particular focus on adherence to established guidelines.

METHODS

This nationwide cross-sectional survey was conducted between April and October 2024 among general practitioners and specialists using a semi-structured questionnaire. Information on demographic characteristics, diagnostic and therapeutic practice patterns, and use of clinical guidelines was collected. Descriptive statistical methods were applied.

RESULTS

Among the 643 practicing physicians, 553 (86%) were specialists in Gynecology and Obstetrics, followed by general practitioners (7.8%), endocrinologists (4%), and others. The European Society for Human Reproduction and Embryology (ESHRE) was the most commonly followed guideline (37%), along with other evidence-based guidelines. Infertility, irregular menstrual cycles, and hirsutism were frequent presenting symptoms, while infertility, type 2 diabetes, and obesity were identified as major long-term risks. Lifestyle modifications (515, 80%) and metformin (466, 72.5%) were the most common treatment strategies. Overall, 573 (89.1%, 95% CI: 86.7%-91.5%) physicians reported applying at least one recognized guideline. However, advising follow-up varied, with only 180 (52%) recommending follow-ups within 12 weeks. Furthermore, 465 (74.6%) participants who wanted a referral system supported the establishment of a structured referral system, with endocrinologists and gynecologists as the preferred specialists.

CONCLUSION

While most physicians reported familiarity with international guidelines, variations in adherence and follow-up practices were observed. The development of a unified, context-specific national guideline is recommended to strengthen standardization of care and improve patient outcomes in Bangladesh.