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Polycystic ovary syndrome (PCOS) is a complex condition requiring multidisciplinary care. Six years ago, endocrinologist Lekshmi Nair, MD, set out to provide that care to her patients at the Ohio State Wexner Medical Center, creating a PCOS clinic that would approach symptom and risk management through a multispecialty lens.
Dr. Nair is a clinical assistant professor of Internal Medicine in the Division of Endocrinology, Diabetes and Metabolism in the Ohio State College of Medicine. In fall 2017, she started treating women with PCOS at a dedicated clinic within the Center for Women’s Health.
“The idea was to create a clinic that could specifically help women with PCOS manage their current symptoms and future health risks across multiple facets,” Dr. Nair says.
That meant treating patients as an endocrinologist alongside a trusted gynecologist partner. Initially Dr. Nair relied on the expertise of Ob/Gyns in the Center for Women’s Health to help treat patients, but in 2019, Loriana Soma, MD, clinical assistant professor of Obstetrics and Gynecology in the College of Medicine, joined as co-manager of the PCOS Clinic to focus on the reproductive comorbidities of the condition.
“The clinic is unique and collaborative because it’s between specialties,” Dr. Nair says. “Now if I have a question about a patient’s reproductive health, I can quickly communicate with someone who I’m comfortable with and who knows the patient, and, in turn, she can ask me a question from an endocrine standpoint.”
Benefits of multidisciplinary PCOS care
There isn’t a cure for PCOS. The exact cause is also unknown. But the factors at play and resulting symptoms come from multiple systems in the body. For example, the numerous small cysts that may appear on a patient’s ovaries are related to their hormones and endocrine system, and the symptoms often manifest in a patient’s metabolic and hormonal system, in addition to their gynecologic system. That means treatment must be comprehensive.
“There are a lot of facets to PCOS, so it’s important for these patients to have a whole team taking care of them,” Dr. Soma says. “There are many different complications that can arise, including infertility and type 2 diabetes.”
While Drs. Nair and Soma offer patients with PCOS preventive screenings for metabolic and reproductive complications, they also provide education.
“Understanding the disease and understanding some of these potential consequences helps patients,” Dr. Nair says. “It’s not A to Z, but it’s moving them along that progression. A lot of times these patients just get a label attached to them without really knowing anything about the condition or the interventions available.”
Some of the interventions are lifestyle modifications, which can be challenging for patients.
“Anything that requires a lot of lifestyle interventions can be tough because there are so many barriers in our culture and society that make them hard to achieve, but our clinic brings resources together that a patient might not be able to get from just an endocrinologist or just an Ob/Gyn,” Dr. Nair says.
Because of the clinic, for example, Dr. Soma can help patients with PCOS achieve fertility and then serve as their Ob/Gyn during their pregnancy.
“I think it’s nice that they can see me on a continuum over time,” she says. “That’s not typical for patients with PCOS.”
The multidisciplinary approach to care doesn’t stop at endocrinology and gynecology. Drs. Nair and Soma often refer patients to additional specialties — such as dermatology, psychology and nutrition — to help manage other symptoms that can present with PCOS.
Dr. Soma has an interest in the cross-section between PCOS and nutrition. She recently helped submit a grant request for a study that would look at how nutrition — specifically, the keto diet — could help regulate menstrual cycles and ovulation for patients with PCOS.
It’s just one example of the way a multidisciplinary approach to PCOS can benefit the patient.
“Patients appreciate having one place to go where they can get help with multiple areas, all while focusing on their specific condition,” Dr. Soma says.
