Development of a structured education programme to improve cardiovascular risk in women with polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is a chronic condition with a reported prevalence of up to 18% and is associated with adverse long term outcomes. Structured education programmes have proved effective at optimising physical activity, biomedical outcomes and well-being of people with chronic conditions, however, pragmatic structured education interventions in women with PCOS are lacking. Aim: To develop an evidence-based structured education programme for women with PCOS and increase their step-count. Methods: Using a local multi-ethnic database, phenotypic presentation and long term cardiovascular outcomes of women with PCOS was determined. The attitudes of women with PCOS towards an education programme and their experience of living with PCOS was sought through qualitative interviews. A systematic review compared lifestyle interventions with insulin sensitizers in PCOS. Using the Medical Research Council’s framework, the SUCCESS education programme was developed and tested in a randomised controlled trial. Key Findings: • There are phenotypic differences in women with PCOS according to ethnicity or body weight. • Overweight and obese women with PCOS have a high proportion of cardiovascular risk factors and higher age-specific rates of myocardial infarction as compared to general female population. • In a meta-analysis, no statistical differences exist between the effect of lifestyle interventions and Metformin on BMI at six month. • Women with PCOS welcome group education programmes. They have significant body image issues, which has an emotional impact. • The SUCCESS education programme did not increase the step count at three month. Conclusion: This project established the high cardiovascular risk associated with PCOS. Although, the SUCCESS education programme did not show positive results at three months, it is the first pragmatic structured education programme tailored to women with PCOS. Outcomes at the final analysis in 12 months, will inform whether the programme should be implemented or adapted further and re-evaluated.