Clinicians: Pay Attention to Body Image Concerns in Patients With PCOS

CHICAGO — All women with polycystic ovary syndrome (PCOS) should be assessed for body image concerns, a researcher here urged.

In a systematic review and meta-analysis, significantly more women with PCOS struggled with several factors playing into body image and self-esteem, reported Punith Kempegowda, MBBS, MD, PhD, MSc, of the University of Birmingham in England.

Measured via the Multidimensional Body-Self Relations Questionnaire Appearance Scales (MBSRQ-AS), women with PCOS scored on average 0.78 points (95% CI -0.90 to -0.65) lower on how satisfied they were with their physical appearance compared with otherwise healthy women, he said in a presentation at ENDO 2023, the annual meeting of the Endocrine Society.

Women with PCOS also scored significantly higher on the appearance orientation scale compared with healthy women, meaning they placed a larger importance and personal investment into their appearance (mean difference 0.22, 95% 0.07-0.36).

These women also scored significantly worse on MBSRQ scales looking at preoccupation with being overweight — including concerns like fat anxiety and restrained eating — self-classified weight, and satisfaction with specific body areas.

“Diagnosing body image concerns might give us an opportunity to address patient concerns. It’s about what they want, what they think about themselves, and this is an opportunity for us to work with them,” Kempegowda said during a press conference.

He suggested clinicians have PCOS patients fill out the body image scale questionnaires, as used in this meta-analysis, in order to pick up on patients who are struggling with these concerns without adding to the length of consultation appointments.

And when it comes to caring for these patients with body imagine concerns, the first step is to simply acknowledge and validate them, Kempegowda advised. “They feel a lot happier seeing that someone is looking into it.”

“Most women, at least in my consultations, do not need to be referred to a psychologist,” he told MedPage Today. “They need to be acknowledged and they need to be provided help, [starting with] nonpharmacological treatment. There are medicines that can work too, depends on which one we’re talking about. If we’re talking about weight being the predominant factor causing the body image concerns, there are weight-loss medicines we can consider, and if it’s excess hair, there are [other] medicines.”

Unfortunately none of these pharmacological treatment options are specifically indicated for PCOS, he added, but can still be used off-label.

“But first step is acknowledging it, supporting, and listening to what they think is needed, and despite all the best measures if it’s not working, then we start looking at medicines,” he suggested.

He added that his group shared these PCOS body image screening recommendations with the international guidelines groups. Guidance for PCOS assessment and management were initially released in 2018 and Kempegowda said the 2023 guideline update is expected late summer or fall.

The nine studies included in the meta-analysis represented 918 women with PCOS from Europe, South America, the Middle East, and Asia who were compared with 865 women without PCOS.

“This is not just a first-world problem,” said Kempegowda. “Somebody made a comment that this is ‘woke medicine’ … it’s not a first-world problem and it’s not a Western-world problem. If it’s 10% of women in the world according to conservative estimates, that’s about 1 billion women. That’s a lot of women who are affected with this.”

“This study confirms the impact that PCOS has on patients’ quality of life, in particular their body image self-perception,” commented Ricardo Azziz, MD, MPH, MBA, of the University of Alabama at Birmingham, who wasn’t involved with the study.

In another study presented at ENDO, Azziz’s group found that the prevalence of PCOS in U.S. health system and insurer records is two to 33 times less than the prevalence of PCOS in the population, according to NIH criteria, potentially reflecting a lack of awareness and understanding among healthcare providers paired with a reluctance of patients to seek care, they suggested.

“Women with PCOS have significant quality of life burden, which is often unrecognized,” he told MedPage Today. “The study used a systematic review and meta-analysis approach emphasizing patients seen in the clinic, and [Kempegowda’s group’s] findings need to be confirmed studying PCOS patients in medically unbiased settings.”

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