Professor Gerard Conway
Munday Books (November 2016)
Paperback. Price £14.99
Order directly through: www.pcosyourmedicalhandbook.com
Reviewer: Mr Mike Savvas, Consultant gynaecologist, Department of Women’s Health, King’s College Hospital, London
Member of the medical advisory council , British Menopause Society
This is an excellent volume written by Professor Conway who has many years of experience in looking after women with PCOS. It is comprehensive, dealing with the various aspects of PCOS in a language and style that is easy to understand. Even complicated concepts, such as insulin resistance is presented in a way that can be understood by the non-specialist.
The author describes the current definition of PCOS, the various symptoms and manifestations of this condition as well as the investigations required to confirm the diagnosis. There is detailed clear discussion on the various treatment options for the different symptoms of PCOS and throughout the book there is strong emphasis on how various symptoms can be improved with lifestyle changes.
The chapter on ovulation and infertility is particularly helpful because fertility is often a major cause of anxiety for women with PCOS. The author explains that many women with PCOS will get pregnant without delay if they have a regular menstrual cycle. The overall the chance of getting pregnant if normal weight is achieved and the woman is 38 years old or younger is 90%. The author discusses the menstrual cycle and provides reassurance to women that having a regular cycle would indicate that ovulation is occurring. Ovulation testing using the home testing kits is discussed and importantly explains that in the 30% of women with an elevated LH these tests can be misleading as they will show continuous weak positive results. The author goes on to discuss the other causes of infertility including Fallopian tube problems or male factor. In discussing the various treatments of infertility the author emphasises the importance of weight loss – both for improving fertility and to reduce the risk of complications in pregnancy. Ovulation induction is also discussed with the use of Clomiphene and also discusses the newer evidence surrounding the use of the newer drug, Letrozole. Ovarian diathermy or drilling and IVF are also discussed in this concise and informative chapter.
There is also an important chapter on the long-term health issues with PCOS with the association of type 2 diabetes. Whilst many authors suggest an increased risk of heart disease with PCOS the latest evidence is discussed which shows that long-term studies have not found any evidence for this. It is curious that the risk factors for heart disease seen in PCOS do not seem to translate to an actual increase in heart attacks. While it is clear that further research is required Conway explains that obesity is such a strong influence on heart disease risk that it is hard to separate out an independent risk related to PCOS itself.
The association with type II diabetes is stressed and advises that women who have a family history and are therefore at an increased risk should be screened an early stage.
The final chapter again discusses life style changes with exercise and other alternative treatment for help with weight loss which includes CBT, mindfulness, acupuncture and different diets are explained.
This is a very well written, easy to understand and comprehensive book on PCOS. It is clearly aimed at women with this condition, but I think it would also be of value to GPs and other doctors working in this field, particularly trainees.