Diagnostic and Treatment Delays Regarding PCOS Final.docx

This is a research paper evaluating the causes of delays in diagnostic and treatment of poly-cystic-ovary syndrome, with proposed solutions, as well as an overview of stakeholders involved.

1. Diagnostic and Treatment Delays Regarding PCOS
Ellie Coleman
School of Health Administration, Texas State University
HA 5356
Dr. Pradhan

2. 05/02/2025
Poly cystic ovary syndrome is the most common endocrine disorder of
women of reproductive age, but remains underdiagnosed, undertreated, and
under-researched. This paper explores the multifaceted barriers that patients face
in receiving a timely diagnosis and treatment. Drawing from current literature on
the topic, this paper identifies the key groups impacted by disease-related health
policies, such as patients, healthcare providers, researchers, health agencies, and
the general public. Three policy interventions are proposed, of a national
standardized diagnostic criteria, increased research to the field, and mandated
provider education on poly cystic ovary syndrome. The use of a decision matrix
concluded that the implementation of a national standardized diagnostic criteria
would be the most viable solution to the problems identified. Reforming poly cystic
ovary syndrome diagnosis through standardized criteria could lead to broader
improvements in research, treatment access, and long term health outcomes.
Keywords: PCOS, Poly cystic ovary syndrome, Reproductive Health

3. PCOS is a disorder which affects women worldwide. It is the most common
endocrine disorder in women of childbearing age, and is incurable, although
symptoms can be managed.
There is a severe lack of awareness and education among healthcare
providers on the disease
Despite the high prevalence and the debilitating symptoms that are
associated with PCOS, no direct cause has been established, and research in
the field is low.
Comprehensive care is not available to every patient.
A standardized diagnostic criteria would result in a more effective diagnostic
process.
Mandatory education and continuous training for healthcare providers
would improve both quality of care and patient experience.

4. Poly Cystic Ovary Syndrome, or PCOS, is a metabolic disorder that
affects women of childbearing age. PCOS presents with a variety of diverse
characteristics, and patients suffering from this disorder can experience different
symptoms and may each respond differently to treatments, resulting in a much
more difficult diagnostic process. There is believed to be both genetic and
environmental components to disease development (Dapas & Dunaif 2022),
although despite the high prevalence and the debilitating symptoms that are
associated with poly cystic ovary syndrome, no direct cause has been established,
and research in the field is low. From my own experience, it is very difficult for
patients to receive a PCOS diagnosis, let alone proper treatment, due to a variety
of roadblocks. I believe that these roadblocks can be properly addressed and

5. reduced via a series of changes within the field of health care, including health
policy changes and increased awareness and education.
Currently, there is no standardized diagnostic criteria for evaluating PCOS,
however, the Rotterdam Criteria is the most widely used; with the use of this
criteria, patients must have at least two out of the following three symptoms:
hyperandrogenism (excessive androgen hormones), either irregular or complete
lack of ovulation, or cysts in the ovaries. Not every woman with PCOS experiences
each or multiple of these symptoms, which can complicate the diagnostic process.
According to Chang and Dunaif (2021), the field of PCOS research as a whole is
severely underfunded, leading to a lack of evaluation of current diagnosis criteria,
treatment and therapies, as well as long-term outcomes.
While poly-cystic ovary syndrome is becoming much more well-known, there
is a severe lack of awareness and education among healthcare providers. Many
women who receive a professional diagnosis do so after having done their own
research. They often go through multiple healthcare providers over several years
before finding a doctor who takes their concerns seriously, and one who is
adequately educated on the subject (Ismayilova & Yaya, 2022). Even health care
professionals that have heard of the disorder are severely lacking in the ability to
recognize and manage the PCOS symptoms that their patients face.

6. Even when diagnosed, there is limited access to comprehensive PCOS care,
tailored to the patient. Standard therapies target specific symptoms of PCOS, and
comprehensive care is not available to every patient. Depending upon the patients
care goals, many of the therapy options currently available to PCOS patients can
cause a multitude of side effects. One example is the use of birth control to treat
all phenotypes of PCOS, regardless of patient presentation (Papadakis et al. 2021);
despite different potential treatments, it is one of the catch-all treatments that is
applied across the disease. Even the common medications used to treat the
various symptoms of PCOS are not disorder-specific interventions, such as the use
of the diabetes drug Metformin, which has been proven to aid in insulin resistance
in PCOS patients, however, also raises some safety concerns (Lui et al. 2021).
As established previously, PCOS is a disorder which affects women
worldwide. It is the most common endocrine disorder in women of childbearing
age, and is incurable, although symptoms can be managed (Islam et al. 2022). In
the United States, prevalence of this disorder is between 5-10% of reproductive
age women, while worldwide it is estimated to affect between 6 and 13% of
women (Salari et al. 2024), with an estimated 70% of cases going undiagnosed. The
experience of many women seeking a PCOS diagnosis is facing roadblock after
roadblock. Following a diagnosis, many women not even receive full transparency
about the potential issues surrounding the disease (Sydora et al. 2023). The

7. experiences of the women that Sydora et al. (2023) interviewed follow much of
what has been said previously, highlighting the necessity for general awareness
both within the general population as well as the health care field, more resources
within research and the medical field, and greater access to informational
resources.
Until 2012, consensus conferences over the diagnostic and treatment
practices for PCOS were held by the National Institute of Health to evaluate the
efficiency of the current practices, and discuss new research in relation to these
procedures (Chang & Dunaif 2021). These have been replaced by evidence-based
guidelines for diagnosis and management of PCOS, however, are not of the same
quality. According to Chang and Dunaif (2022), the quality of the data used in these
guidelines are fairly low, due to the scarcity of the clinical trials needed to secure
this data. They claim that the guidelines themselves are not adequately
implemented as well, caused in part by the lack of funding to the field discussed
previously. The guidelines themselves ranked current recommendations as lacking
evidence- out of 175 recommendations, 31 were considered evidence based.
There are various stakeholders that would have an interest in policy, health,
and education reform regarding PCOS. First and foremost, the PCOS patients
themselves would be the largest stakeholder involved in reform, as they are the
ones who are most affected; they would be most affected by health care reform, as

8. the updated treatments and therapies would allow them to live their life very
differently. Research reform, or allocating a much larger budget to PCOS research,
would affect a number of parties, including health care professionals and health
agencies. Health care professionals would need to stay updated and informed on
the changes in standard of care, as well as any new findings or treatments
available. Health care providers’ ultimate goal is to do no harm- this includes
treating their patients with the most up-to-date and efficient therapies. Health
agencies are focused on providing the most up to date information about different
diseases to both the public and to health care providers; agencies such as the
National Institute of Health have already displayed an interest in the PCOS
diagnosis and treatment processes (Chang & Dunaif 2022) and would definitely be
affected if any developments were to occur in either. Researchers in the field would
also be affected if reform were to happen, as they would be allowed to study PCOS
and its effects at a much greater depth. There would not be a true governmental
policymaker involved in this type of change, however, the health agencies would be
the closest to this, as they would be the ones to recommend the best diagnosis
and treatment practices. The public, or individuals that are not patients, health
providers, nor associated with any health agencies would be another stakeholder
in this, however, one that I believe would be fairly low interest. As stated previously,
while PCOS is beginning to be more well-known and discussed, it is still a relatively

9. unknown disease to many. Even within a cohort of medical students, only around
half of them had “good” knowledge of PCOS (Subhashree Bangaru et al. 2021); this
is an indicator that the knowledge of the general public on PCOS is fairly low.
Despite the perceived low interest, the public has a very large influence on a
variety of outcomes within society- the “court of public opinion”.
Table 1:Stakeholder's Power/ Interest Chart
Health policy is defined by the World Health Organization as the plans and
actions taken in order to realize specific health care goals that protect and
promote the health of individuals within a community (Walden University n.d); this
Health Agencies
Health Providers
Researchers
Patients
Public

10. is a very important aspect of health care, as it ensures that individuals have fair
and equal access to medicine. It promotes the health and well-being of individuals
through legislation and advocacy. Health policy can be used to impact a variety of
issues in both positive and negative ways, with the ultimate goal of solving a
problem within health care. In the case of poly cystic ovary syndrome, the goal of
using health policy is to improve overall care and treatment, increase access to
treatment, and promote the prevention and treatment of the disease. Using a
variety of techniques, health professionals will be able to eliminate the different
roadblocks that patients suffering from poly cystic ovary syndrome face.
There are several different policy instruments that could be used to solve the
issues surrounding poly cystic ovary syndrome; these include economic and
financial, regulatory, and social and cultural instruments, among many other
potential solutions. The potential economic and financial instruments include
greater funding into reproductive research, as well as into public health initiatives.
Increased funding into reproductive research can lead to better treatments, and
ultimately much more individualized and successful care. Public health initiatives
that focus on early diagnosis and general education of the disease and symptoms,
as well as screening for the disease, can allow for early intervention which reduces
the chance of developing some of the more long-term and debilitating facets of
the disease. Some of the regulatory instruments that could be used is that of

11. standardizing the clinical guidelines for diagnosing and treating poly cystic ovary
syndrome, as well as regulating comprehensive treatment access. Developing and
implementing a standardized treatment for poly cystic ovary syndrome, nationally
or internationally, would result in a more effective diagnostic process. Currently,
different providers follow different practices and guidelines, leading to delays in
diagnoses, inconsistent care, and even inappropriate treatment approaches; with a
standardized approach that includes clear diagnostic criteria and screening
protocols, providers can individualize treatment, provide consistent and equitable
care, and improve their patients’ health outcomes. Regulating access to
comprehensive treatment for poly cystic ovary syndrome sets standards for ethical
practices and builds on the idea of providing consistent and efficient treatment to
patients. This would allow for a more integrated approach to poly cystic ovary
syndrome care, which also promotes preventative measures. The potential social
and cultural instruments include public awareness campaigns and culturally
competent care initiatives. Launching campaigns, whether national or small-scale,
raise awareness for poly cystic ovary syndrome, as well as the disease’s symptoms
and impact on health; this can be done through a variety of means, such as a TV
broadcast, via social media, or schools and community organizations. This helps to
call attention to and explain poly cystic ovary syndrome, reduce stigma
surrounding the disease, and to point out the potential health complications to

12. encourage individuals to seek early diagnosis and treatment. Culturally competent
care is a very important aspect of the social and cultural instruments, as it allows
providers to understand the different ways that poly cystic ovary syndrome can
manifest in various racial and ethnic groups. A cultural competence training for
healthcare providers also ensures that patients with different ethnic and cultural
backgrounds receive personalized and appropriate care, while addressing any
potential cultural or language barriers to treatment.
Three alternative policies that could be used to address the disparities found
with the poly cystic ovary syndrome diagnostic and treatment processes include
establishing a national standardized diagnostic criteria, increased research funding
for disease-specific treatments, and mandatory education and continuing training
for health providers on poly cystic ovary syndrome. Creating a national
standardized diagnostic criteria would ensure that each provider would
consistently evaluate each patient with the same guidelines, reducing the chances
of misdiagnoses for other disorders, and improving clinical outcomes due to early
intervention. One potential complication of the standardized criteria is that poly
cystic ovary syndrome does present in a variety of ways, with different
manifestations of the disease. Not all women who suffer from the disease display
the classic symptoms, which often result in providers completely missing or
misdiagnosing for another disease. If standardized criteria are formed based on

13. the traditional symptoms, cases with milder or atypical symptoms could be missed.
There is also the potential for health providers to potentially refuse to use the
updated criteria due to a variety of reasons, such as a lack of understanding or
familiarity with the guidelines, a reliance on the existing criteria, or a reluctance to
change from what they are used to. Increased research funding would lead to
more disease-specific treatments, with much more effectiveness. Currently, the
treatments that are available to patients with poly cystic ovary syndrome only treat
symptoms of the disease, and their primary use are for other disease, such as the
use of metformin, a diabetes drug; these medicines can also come with a long list
of negative side effects. One possible negative is the current lack of research-
without comprehensive data on patient outcomes and the impact of early
intervention, it is difficult to create disease-specific treatments. Mandatory
education and continuous training for healthcare provider would improve both
quality of care and patient experience by ensuring that providers are better
equipped to recognize, diagnose, and manage poly cystic ovary syndrome. It
would improve equity by promoting a more consistent and sensitive approach by
providers across different groups of individuals, however, it could also incur
additional costs and administrative burdens for health institutions, especially in
more rural or underfunded areas.

14. The five evidence-based criteria with which I will evaluate the three
proposed policies are effectiveness, cost effectiveness, feasibility, equity, and
patient experience. Effectiveness is how well a policy will achieve its intended
outcomes, such as reducing the prevalence of a disease and improving health
outcomes in patients. This is a quality which can be measured through a series of
steps as outlined by the CDC (Center for Disease Control n.d). Cost effectiveness
measures whether the costs of implementing a policy outweigh the benefits that
the policy will provide. There are several analyses with which this can be measured
(Center for Disease Control, N.d). Feasibility is the evaluation of the practicality and
achievability of a policy, with an emphasis on data, resources, and measurement of
the policy; it can be measured with feasibility studies to build ad test
implementation strategies (Pearson et al. 2022). Equity is the concept of whether a
policy benefits every individual or groups within a community fairly. There are
several ways to evaluate this, such as determining utilization patterns of
underrepresented groups (Hoyer et al. 2022). Patient experience is the concept of
patient satisfaction and a patient’s interaction with a system or policy. While more
abstract than the other criteria, patient experience can still be measured in a
qualitative capacity; measurement methods such validated surveys allow for health
care professionals to greater understand the impact of a policy on patients and the
interactions with their care (Larson et al. 2019).

15. Each of the five stakeholders that I previously defined, health
agencies, health providers, researchers, patients, and the general public each
would hold those five criteria to different levels. Health agencies, such as the World
Health Organization, would view cost effectiveness, feasibility, equitability and
effectiveness as the most important factors, as they would most likely be involved
in the implementation and strategy of the policy itself; their goal as a health
organization is to improve the lives and health of individuals as well, meaning that
they would want to make sure the policy worked, and impacted all equally. Health
providers would view feasibility and patient experience as the most important, as
while they are not involved in the policy implementation itself, the policy will
definitely impact their daily work; they will also be impacted positively, or
negatively, depending on the response from patients. Researchers would be most
impacted by cost effectiveness and feasibility, depending on the policy itself; there
is the potential for a costly program initiative to pull funding from other budgeted
programs, or a policy could include increased funding to certain research
programs. Patients, or those suffering from the disease itself, would view equity
and patient experience as the most important. Patients would want to make sure
that the implementation of a policy or program would be equitable and fair to all
individuals and underrepresented groups and would want to ensure that this
policy creates a more positive experience for them, with an overall improved health

16. system. The general public, or those not directly impacted by the disease, would
view cost effectiveness as the most important factor. They would not have a direct
interest in the policy or implementation itself but would be more interested in the
potential use of tax dollars or other budget-related issues.
Stakeholder’s Response to
Five Evaluation Criteria Cost-
Effectivenes
s
Feasibilit
y
Equitabilit
y
Effectivenes
s
Patient
Experienc
e
Health Agencies 5 4 3 4 4
Health Providers 2 3 3 4 5
Researchers 4 4 2 3 2
Patients 1 2 5 4 5
General Public 5 2 3 2 1
Table 2: Stakeholders’ Perspective Ratings for the Five Evidence-Based Evaluation Criteria. Values are 1, 2, 3, 4, 5, and
reflect Very Unimportant, Somewhat Unimportant, Neutral, Somewhat Important, and Very Important, respectively.
The issues regarding poly cystic ovary syndrome identified and outlined
previously include a lack of standardized criteria, lack of disease-specific
treatments, and inadequate awareness among healthcare professionals and

17. providers. The policies that I feel would best help to solve these issues include
establishing a national standardized diagnostic criteria, increased research funding
for disease-specific treatments, and mandatory education and continuing training
for health providers on poly cystic ovary syndrome itself, respectively. In order to
determine the most viable solution for solving these issues, I created a decision, or
comparison, matrix. This matrix evaluates each of the potential solutions based on
a series of criteria including Cost Effectiveness, Feasibility, Equitability,
Effectiveness, and Patient Experience. The decision matrix is weighted by which
criteria is more important to the issues surrounding PCOS. I also gave each
potential policy a score between 1 and 5, in each of the criteria, which measured
how well I believe each potential policy to adhere to the criteria; for example, I
ranked the Increased Research Funding at a 2 for cost effectiveness, as this would
increase costs for involved agencies. This decision matrix can be referenced in the
appendix. I determined that cost effectiveness and policy effectiveness should be
weighted 25%, improving patient experience should be 20%, and both equitability
and feasibility should be 15%. For the National Diagnostic Criteria suggestion, I
determined that it had a total score of 4.4, with a 1 in cost effectiveness, 0.6 in
feasibility, 0.75 in equitability, 1.25 in effectiveness, and 0.8 in improving patient
experience. Increased Research and Funding had a total score of 3.35, with a 0.5 in
effectiveness, 0.45 in feasibility, 0.6 in equitability, 1 in effectiveness, and 0.8 in

18. improving patient experience. Mandatory Education and Training for healthcare
professionals had a total score 3.85, with 0.75 in cost effectiveness, 0.6 in
feasibility, 0.45 in equitability, 1 in effectiveness, and 1 in improving patient
experience. Based on the weighted decision matrix, the creation of a National
Diagnostic Criteria seems to be the most viable option to properly solve the issues
surrounding poly cystic ovary syndrome, as it has the highest score out of the
three possible solutions. It is the most cost effective, the most overall effective, and
the most equitable to all involved according to the decision matrix.
A national standardized diagnostic criteria, such as one building on globally
recognized diagnostic framework such as the Rotterdam Criteria, would allow for
consistent and accurate diagnosis of the disorder. A standardized criteria also
ensures that providers are able to recognize the typical or classic poly cystic ovary
syndrome presentations and symptoms, leading to a much earlier diagnosis and
earlier intervention for better patient outcomes. It would reduce the chances of
misdiagnosis and dismissing patient concerns, as poly cystic ovary syndrome
symptoms can overlap and mimic those of other conditions. Involvement of certain
women’s and reproductive health organizations, as well as major health
organizations such as the World Health Organization, to develop and roll out this
criteria would make sure that it is accurate and widely accepted across health care
systems; this ensures consistent implementation across various health care

19. settings and a greater trust in the tool among health care providers and patients
both. The poly cystic ovary syndrome diagnostic criteria could be integrated into
medical curriculums and training to make sure that all health care providers are
following the same standards, regardless of their status. It could be used as part of
a yearly check up in several health care settings, in order to catch the disease as
early as possible and medically intervene.
Changing the weights associated with the various criteria within the decision
matrix would most likely not change which potential policy would be considered
the most viable. The national standardized diagnostic criteria would most likely still
be considered the most viable regardless of weight changes within the categories,
as it was the most cost effective, the most overall effective, and the most equitable
to all involved, as mentioned previously. Should these three criteria end up ranked
relatively low, the standardized diagnostic criteria policy would still most likely stay
ranked high. Mandatory education and training for health care professionals had
the second highest score, and had the highest rank within improving patient
experience, and tied with national diagnostic criteria in feasibility. Another
approach is that of looking at the scores that I gave each of the potential health
policy suggestions which measured how well I believed each potential policy to
adhere to the criteria that I outlined, on a scale of 1-5. The diagnostic criteria had
the highest total score in this aspect, with a total of 23 out of a possible 25. The

20. second highest score was mandatory education and training, with 20 out of the
possible 25. Despite the weights for each category, the standardized diagnostic
criteria still has a much higher score, and any weighted changes would not be
enough to overcome this gap.
The five stakeholders that I identified would have an interest in the issues
surrounding poly cystic ovary syndrome are health agencies such as the World
Health Organization, researchers in the reproductive field, health care providers,
poly cystic ovary syndrome patients themselves, and the general public, or anyone
who is not a provider, associated with a health care agency, or a patient. The
chosen policy recommendation, a national standardized diagnostic criteria would
receive mixed reactions from the aforementioned stakeholders, both positive and
negative. Beginning with health agencies, they would view the development and
implementation of a national standardized diagnostic criteria in a supportive and
strategic manner, viewing it as a step toward improved public health outcomes.
The various health agencies would also work to incorporate the criteria into
national clinical guidelines, promoting it in a variety of ways to health care
professionals and providers. They could potentially align it within existing
reproductive recommendations and emphasize monitoring the real-world impacts
of the criteria, specifically in regard to diagnoses and timelines of care, and use the
data to refine and update the criteria over time. Researchers in the reproductive

21. health field would most likely view the diagnostic criteria in both a positive and
negative lens. While the criteria would be a major step forward for improved data
and research consistency, allowing for each patient to be evaluated with the exact
same criteria which reduces variability in cases. This strengthens the validity of
data and clinical trials, with larger and more comparable data sets, that allow
researchers to study the disease and its effects much more in-depth. Having
established this, researchers would also evaluate the criteria much harsher. Overly
rigid criteria that is built solely on traditional or classic disease manifestations
could end up missing patients with atypical disease presentation and could even
end up weakening the research on the subject; exploration of emerging diagnostic
tools could be limited, and even research into these atypical presentations. Health
care providers, much like researchers, would have mixed views on the diagnostic
criteria. While a clear framework would allow for providers to feel more confident
in a diagnosis, there could be concerns regarding both atypical disease
manifestations and the application of criteria to cases such as those in teenagers
or young adults, both of which need a more flexible approach to diagnosis. There
is also the potential issue of providers refusing to utilize the updated and
standardized criteria, due to a variety of reasons including a lack of understanding
or familiarity with the new guidelines or reliance on existing diagnostic processes.
Poly cystic ovary syndrome patients who have classic presentations of the disease

22. would react in a positive way, as poly cystic ovary syndrome is often overlooked for
misdiagnoses of other disorders. Patients face potential years of delayed
diagnosis, and conflicting information. With a standardized criteria, new cases
could be identified sooner and more accurately, and would instill a sense of relief
in patients that those seeking a diagnosis could avoid the stress and hardships
that they did. The general public, or anyone who is not a poly cystic ovary
syndrome patient, a health care provider, nor associated with a health agency,
would most likely respond to a national standardized criteria with a neutral or
supportive tone, depending on their level of awareness of the disease. As
mentioned previously, poly cystic ovary syndrome is a relatively unknown disease
even to health care professionals, despite the fact that it is the most common
endocrine disorder of women of reproductive age. It is often overlooked in favor of
other public health issues, and is not widely understood outside of medical or
patient interactions. Those who are aware of the disease or are familiar with
someone who is affected by it would be supportive of the policy, as they would
understand the difficulty patients face to a certain extent.
I believe that the national standardized diagnostic criteria would be a
relatively feasible policy to implement. It is relatively low cost, outside of the costs
associated with development, and any costs associated with implementation
within the medical system would be low in comparison with other potential

23. solutions. Potential constraints however do include the fact that any health policy
changes are slow to enact and require a high level of coordination across multiple
federal agencies, such as the Center for Disease Control. The process of developing
official clinical guidelines is long, and requires committees, reviews, and revisions
which can all be delayed by shifting priorities and other governmental setbacks. A
new administration could completely shift focus away from reproductive health
initiatives, which could delay or even completely reverse any progress made.
Another issue I could see is the logistics of implementing a new criteria across
both rural and urban areas, which creates a large disparity. Patients in different
areas of the country, such as in the more rural areas, may not have access to the
facilities or equipment that those living in more urban areas would. This disparity
could result in pushback from different levels of government and the healthcare
system. Poly cystic ovary syndrome, and reproductive health as a whole, is severely
underfunded in research, and without substantial data to back up criteria, and
funding to support it, it could be hard to develop and effectively implement a
national standard.
   
Cost
Effectiveness
(25%)
 
 
Feasibility
(15%)
 
 
Equitability
(15%)
 
 
Effectiveness
(25%)
Improving
Patient
Experience
(20%)
 
Total
Score

24.  
National
Diagnostic
Criteria
 
4 x 0.25 =
1
 
 
4 x 0.15 =
0.6
 
5 x 0.15 =
0.75
 
5 x 0.25 =
1.25
 
4 x 0.2 =
0.8
 
4.4
Increased
Research
Funding
 
2 x 0.25 =
0.5
 
3 x 0.15 =
0.45
 
4 x 0.15 =
0.6
 
4 x 0.25 =
1
 
4 x 0.20 =
0.8
 
3.35
Mandatory
Education
and Training
 
3 x 0.25 =
0.75
 
4 x 0.15 =
0.6
 
3 x 0.15 =
0.45
 
4 x 0.25 =
1
 
5 x 0.20 =
1
 
3.85
 
Poly cystic ovary syndrome remains one of the most underdiagnosed,
misunderstood, and inadequately treated endocrine disorders, despite its large
prevalence within women of reproductive age worldwide. The central problems of
timely, accurate diagnosis and effective treatment pose a serious barrier to women
affected by the disease, as comorbid diseases are very common long-term with the
disorder. The absence of a cohesive national strategy to identify and treat poly
cystic ovary syndrome represents a failure in clinical practice as well as a systemic
shortcoming in public health policy. Finding an effective and equitable solutions to
Table 3: Comparison Matrix for Potential Health Policy Solutions

25. these problems are not only urgent, but essential, to improving the lives of millions
of affected individuals.
As outlined previously, around 70% of poly cystic ovary syndrome cases go
undiagnosed, which highlights the extent of the inadequacy currently surrounding
its diagnostics and treatment. This translates into late intervention, increasing the
risks for many long term complications, such as diabetes, heart disease, and even
mental health disorders. Even further beyond the physical and emotional tolls on
individuals, untreated or mismanaged poly cystic ovary syndrome can lead to
increased health care costs and reduced quality of life. The path to a
comprehensive solution is complex, as PCOS can manifest in a variety of ways in
patients, with different phenotypes, symptom severity, and comorbidities.
Given these complexities, the recommendation of establishing a national
standardized diagnostic criteria for poly cystic ovary syndrome is the most viable
solution, with the most impact. Based on analysis of the weighted decision matrix,
this policy scored the highest across the 5 evaluation criteria. This standardized
criteria would ideally be built upon existing framework such as the Rotterdam
criteria, while integrating updated research to reflect the most current information
on the disease.
The likelihood of successful implementation of the standardized criteria is
high, especially when it is supported by national health agencies, medical

26. institutions, and professional medical organizations. This would promote the
integration of the criteria into clinical guidelines, medical practice, and continuing
education programs. The costs would be relatively low, especially in comparison to
the benefits like improved patient outcomes, more effective treatments, and
overall effectiveness. Developing the criteria could require significant initial
funding, such as for the research needed, but would ultimately be low cost. This
policy would standardize health care delivery and reduce disparities in diagnosis
and treatment for patients.
One potential issue with the standardized criteria could lead to a missed
diagnosis in patients with atypical disease presentation, as if the criteria is too
narrowly defined, certain groups of patients would be left untreated. Another
concern is that the success of the policy would depend on the willingness and
ability of health providers to fully implement and use them in their practice.
Providers that are resistant to change, experience a lack of training, and those
without the tools needed, could present barriers to implementation.
To address the issues with the standardized criteria, future policy
implementation would need to focus on complementary initiatives and increased
research efforts on poly cystic ovary syndrome; the alternative policies I presented
could be implemented. Following the diagnostic criteria, research exploring the
cause of poly cystic ovary syndrome and the development of targeted therapies

27. must be explored. Studies on patient outcomes, specifically those with early
diagnosis, and the use of different treatment protocols across a variety of
populations must be performed. Mandated education and continuous professional
development over poly cystic ovary syndrome for health care providers would
ensure that the diagnostic criteria are well understood and that they are properly
applied in practice. Finally, public awareness campaigns could be used to educate
the general public on the disease and disease presentations. They should aim to
destigmatize the disorder, promoting early detection, and encourage those who
are experiencing symptoms to seek diagnosis and care.
The multifaceted issues surrounding poly cystic ovary syndrome, and its
diagnosis and treatment, require a decisive, coordinated response. The policies
suggested in this paper offer practical and equitable solutions to a deeply
entrenched issue, with potential improved patient outcomes. Challenges would
still remain, especially with atypical cases and disparities in care access, which
could be addressed with existing policy reform and development of new
supplemental policies. Sustained, collaborative effort that prioritizes patient care
will be critical to reforming women’s health, especially in the context of treating
poly cystic ovary syndrome.

28. References
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https://doi.org/10.1210/endrev/bnac001
Islam, H., Masud, J., Islam, Y. N., & Haque, F. K. (2022). An update on polycystic ovary
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