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

## TL;DR

This study examines how doctors in Bangladesh diagnose and treat PCOS, finding that most follow international guidelines but with inconsistencies in practice.

## Contribution

The study provides insights into physician practices and adherence to guidelines for PCOS management in Bangladesh, highlighting the need for a unified national guideline.

## Key findings

- Most physicians (89.1%) reported applying at least one recognized PCOS guideline.
- Lifestyle modifications and metformin were the most common treatment strategies.
- A majority of participants supported establishing a structured referral system for PCOS care.

## Abstract

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.