By Terrill Bruere APD & Tara MacGregor PACFA Reg Clinical & APD
What is the estimated prevalence of women experiencing PCOS in Australia?
Women with a diagnosis of PCOS come in all shapes and sizes, ages and life stages. They may have just a few symptoms or present with many, which seriously compromise their quality of life. Estimates of prevalence are from 13 to 20 %, making it the most common endocrine disorder for women and there are now International Clinical Guidelines for Treatment 1 published in 2018. Despite this, a comprehensive understanding of working with this population is typically lacking amongst health professionals. Often women with PCOS don’t receive even the first requirement of treatment which is the lifestyle education recommendations of the guidelines.
What is the best advice a Dietitian can provide for a woman experiencing PCOS?
There is no one formula for lifestyle advice for PCOS management but guidelines do allow a Dietitian to translate the available evidence into best practice choices for each individual. The skills to manage a lifelong condition are usually not as simple as knowing what to eat and how to exercise. Some women require education and pointing in the right direction but for others it is more complex and ongoing, and the scope of treatment is wider.
What is essential knowledge for a Dietitian working in this clinical area?
Dietitians can provide excellence in service for clients experiencing PCOS by being aware of the complexities of treatment for this client group. A sophisticated understanding of the lived experience of PCOS can promote the provision of care that clients need on an individual basis and can prevent inadvertently doing harm in this vulnerable client population.
The most common diagnostic issue women encounter is between polycystic ovary syndrome and hypothalamic amenorrhea and Dietitians need to understand the difference and be able to screen for each as the treatments are very different.
Mood and appetite are both altered by PCOS hormones and multidisciplinary treatment has the capacity to stabilize and improve this. Due to the complexity of the emotional and biological factors associated with PCOS however, women can fall between gaps of poorly integrated care where there is not an awareness of this interplay.
For those women that do receive treatment for PCOS, the evidence from quality of life and other research2, 3 demonstrates that our clients’ concerns require more than education around food and exercise. The reliance on BMI as an indicator of individual health and the necessity of weight loss as a health promoting intervention needs to be considered critically. This can be supported when the Dietitian has a sound appreciation of the evidence base for what actually achieves beneficial outcomes in health and contemporary understandings of weight science.
For all women, including those experiencing PCOS, body image and mood concerns are both linked to the ability to make better choices for health and conversely to the risk of developing an eating disorder. Health professionals involved in the care of women with PCOS are wise to consider that the risk of developing an eating disorder is increased amongst this population, which is why screening for these are included in the international guidelines. Our interventions can play a role in the prevention or promotion of disordered behaviors.
The capacity to respectfully have the more difficult conversations about weight, health, bias and stigma is a skill it takes experience to develop. So does identifying the people who may interpret advice being provided, in a way that results inadvertently in an unhealthy preoccupation with food, exercise or weight.
Dietitians are well placed to provide much more in treatment that individual women actually need to achieve lifelong sustainable living with their hormones. Postgraduate training, engagement in professional supervision and establishing clear professional boundaries are the cornerstones to upskilling in this challenging and common presentation.
Where can APDs access training and support for professional development in this area?
Practice Pavestones will be hosting Terrill Bruere APD in Sydney on September 20th facilitating her workshop: Working with Women with PCOS, Navigating the Real-Life Challenges. You can read more about the workshop on the Dietitian Connection Events Calendar or download the workshop flyer. There is the opportunity to attend professional supervision with Terrill following the workshop for the integration of knowledge and skills into your practice.
Feedback from APDs attending PCOS workshop 2017 & 2018
‘This was such a fabulous opportunity to hear from one of the best. Terrill provided clarification on a topic that is so unclear and reminded me of some of the real reasons I do what I do.’ A.T.
‘Terrill has incredible depth of experience. She shared many valuable examples which encouraged us to think more broadly about the experiences our clients are bringing to us. Such a privilege to hear all of her wisdom.’ F.S.
‘This training was honest and down to earth, very practical and useful. Terrill’s honesty about the lack of definite answers in this field was surprisingly refreshing and so reassuring.’ S.W.
‘This workshop was so, so good!…very valuable in summarizing best practice and also tailoring care for each individual woman with PCOS and helping them to navigate their condition and optimize their health’
‘Fantastic workshop! I learnt so much to use in my practice but not just in PCOS – you can apply learnings from this workshop in other areas of Dietetic practice. I hope I can be as experienced as Terrill one day!’ A.M.
‘This workshop was really helpful for anyone working in women’s health and with clients with PCOS. Definitely feel more confident counselling clients using an evidence based and non-diet based approach’ A.O.
About Terrill Bruere APD
Terrill Bruere has been working as a Dietitian since 1982 and has more than 25 years’ experience, specialising in women’s health including positions at Royal Women’s Hospital in Melbourne, Melbourne IVF and Jean Hailes Australia’s leading and most trusted women’s health organisation. She is best known for her work in emotional eating, body image and particularly polycystic ovary syndrome. She has further training in counselling skills and has been training Dietitians in counselling skills for over 18 years. Terrill is a strong advocate for developing broader and more sustainable client centred approaches that fit with the evidence-based practice of a Dietitian. Terrill currently works at the Body Image and Eating Disorders Treatment and Recovery Service (BETRS) for Austin and St Vincent’s Health in Melbourne and in private practice. Terrill provides clinical supervision to Dietitians and is experienced in group facilitation, teaching, resource development and is sought after for her public speaking
- Helena J Teede et al. International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction, Volume 33, Issue 9, September 2018: 1602-618
- Anuja Dokras M.D. Ph.D et al. Androgen Excess- Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertility and Sterility. Volume 109, Issue 5, May 2018: 888-899
- Melanie Gibson-Helm et al. The Needs of Women and Healthcare Providers regarding Polycystic Ovary Syndrome Information, Resources, and Education: A Systematic Search and Narrative Review. Seminars in Reproductive Medicine 2018; 36(01): 035-041