Professional Management of Polycystic Ovarian Syndrome in Gynaecology Outpatient Clinics Across the South East Zone

Polycystic ovarian syndrome (PCOS) is the most prevalent endocrine disorder of reproductive-age women, with long-term metabolic and reproductive health consequences that require structured, evidence-based management. This study evaluates the professional management of PCOS at gynaecology outpatient clinics in the South East geopolitical zone, covering five teaching and specialist hospitals in Imo, Enugu, Anambra, Abia, and Ebonyi States. A mixed-methods design combines retrospective review of 120 PCOS case notes with structured interviews of 20 gynaecologists. Case notes were audited against the International Evidence-based Guideline for PCOS management covering diagnostic workup, lifestyle counselling, hormonal management, insulin sensitiser use, and fertility referral. Biochemical workup was complete in only 38 percent of cases. Lifestyle modification counselling was documented in 42 percent. Metformin was prescribed in 51 percent of cases with documented insulin resistance, and ovulation induction with letrozole or clomiphene was initiated without fertility specialist referral in 44 percent. Long-term metabolic risk counselling was absent in 78 percent of records. Professional recommendations include PCOS management protocol adoption at all South East gynaecology clinics, structured lifestyle counselling documentation, endocrinology linkage for metabolic management, and fertility specialist referral pathways for anovulatory PCOS patients. Keywords: polycystic ovarian syndrome, PCOS management, gynaecology outpatient, South East Nigeria, evidence-based care