A Guide To PCOS: How is Polycystic Ovary Syndrome diagnosed

Polycystic ovary syndrome, more commonly known as PCOS, is a medical condition that is typically diagnosed through a combination of a medical history evaluation, blood pressure tests, a physical examination, and specific diagnostic tests. A healthcare provider will also look at a family history of ovarian syndrome and health conditions. 

The signs and symptoms of PCOS

PCOS can manifest as a variety of symptoms and not all individuals with PCOS will experience the same ones. The severity of these symptoms can also differ. Always consult your healthcare provider to receive a proper diagnosis.

1. Irregular menstrual periods: PCOS often causes irregular or infrequent menstrual cycles. You may experience missed periods, prolonged periods, or unpredictable bleeding patterns.

2. Excess hair growth (hirsutism): PCOS can cause excessive hair growth on the face, chest, back, or abdomen. This hair growth may be coarse and dark and is typically a result of increased androgen levels.

3. Acne: Increased androgen levels can contribute to the development of acne, particularly on the face, chest, and upper back.

4. Weight gain or difficulty losing weight: Many individuals with PCOS struggle with maintaining a healthy weight. Weight gain, especially in the abdominal area, can be common. Losing weight can be challenging, despite efforts to maintain a healthy diet and exercise routine. Excessive weight gain combined with PCOS increases the risk of endometrial cancer in premenopausal people – speak with your healthcare provider if you think you are at risk.

5. Thinning hair or hair loss: Some individuals with PCOS may experience thinning of hair on the scalp, which can lead to hair loss or balding.

6. Oily skin: PCOS can contribute to excessive oil production on the skin, leading to a shiny appearance.

7. Darkening of the skin: Areas of the skin, particularly in the neck creases, groin, and under the breasts, may become darker due to a condition called acanthosis nigricans. This darkening is a result of insulin resistance.

8. Mood changes: PCOS can be associated with mood swings, anxiety, and depression, although the exact relationship between PCOS and mental health is still being studied.

9. Sleep problems: Some individuals with PCOS may experience sleep disturbances, such as insomnia or obstructive sleep apnea.

10. Higher levels of androgens: As mentioned in some of the other points, people with PCOS often experience higher levels of androgens, also known as androgen hyperactivation or excess androgen, which leads to ovulation disorder, menstrual disorder, extra hair growth, and acne. Hyperandrogenism is not only a clinical characteristic of PCOS but also an important risk factor. Speak with your healthcare provider if you think you could be at risk of hyperandrogenism.

It's important to note that not all of these symptoms need to be present for a PCOS diagnosis. The diagnosis is based on a combination of symptoms, physical examination findings, and test results. If you suspect you have PCOS or are experiencing any of these symptoms, we suggest that you speak with a healthcare professional for a proper evaluation and diagnosis.

Diagnosing PCOS

A diagnosis of PCOS can typically be made if other rare causes of the same symptoms have been ruled out and you meet at least 2 of the following 3 criteria:

• Irregular periods or infrequent periods – this indicates that your ovaries do not regularly release eggs (ovulate)
• Hormone imbalance - blood tests showing you have high levels of "male hormones", such as testosterone (or sometimes just the symptoms of excess male hormones, even if the blood test is normal)
• Scans showing you have polycystic ovaries

An ultrasound might not be necessary to diagnose PCOS if the first two symptoms are experienced. Check with your healthcare provider to know which tests and examinations are right for your diagnosis.

Once at a clinic or other medical space, a healthcare provider will begin by asking about your symptoms to help rule out other possible causes and take your blood pressure. After, they may perform a series of other tests and examinations. Here are a few different things you can expect when seeing a healthcare provider:

Medical history assessment

‍The doctor will start by discussing your symptoms, menstrual periods, weight changes, and any other relevant factors that could suggest PCOS. Be prepared to provide detailed information about your menstrual cycle patterns, any issues related to hair growth, acne, or weight gain, and any other symptoms you may be experiencing.

Physical examination

‍The doctor will conduct a physical examination to check for signs of PCOS, such as excess hair growth and facial hair (hirsutism), acne, and signs of insulin resistance (e.g., skin tags and dark patches of skin).

Pelvic examination

‍A pelvic exam may be performed to assess the reproductive organs and check for any abnormalities or signs of other conditions.

Blood tests

‍Several blood tests are usually conducted to evaluate hormone levels and blood sugar levels and rule out other potential causes of your symptoms.

1. Hormone levels: Testing for hormones, including reproductive hormones levels, such as luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, and sex hormone-binding globulin (SHBG) to find any hormonal imbalances.

2. Glucose and insulin levels: Evaluating fasting glucose levels and insulin levels to determine if insulin resistance is present.

3. Lipid profile: Assessing cholesterol and triglyceride levels to identify any abnormalities.

4. Thyroid function: Checking thyroid-stimulating hormone (TSH) levels to rule out thyroid disorders.

Pelvic ultrasound

‍An ultrasound scan of the ovaries and uterus is commonly performed. It helps to visualise the ovaries and detect the presence of multiple cysts (small fluid-filled sacs) on the ovaries. A wandlike device (transducer) is placed in your vagina and emits sound waves that are translated into images on a computer screen. However, the presence of polycystic ovaries alone is not sufficient for a PCOS diagnosis.

Exclusion of other conditions

The doctor may conduct additional tests or evaluations to rule out other possible causes of your symptoms, such as thyroid disorders or adrenal gland abnormalities.

The diagnosis of PCOS is based on a combination of symptoms, physical examination findings, and the exclusion of other potential causes. The specific diagnostic criteria may vary slightly among different medical guidelines and healthcare providers. Therefore, it's crucial to consult with a healthcare professional for an accurate diagnosis and appropriate management of PCOS.

The risks of PCOS

PCOS is a complex hormonal disorder that can lead to various health risks and complications, such as:

1. Cardiovascular disease: People with PCOS have an increased risk of developing cardiovascular diseases such as hypertension, high cholesterol levels, and heart disease. These risks may be due to factors like insulin resistance, obesity, and abnormal lipid profiles commonly seen in PCOS.

2. Endometrial hyperplasia and cancer: People with PCOS often experience irregular menstrual cycles and anovulation (lack of ovulation), which can lead to overgrowth of the uterine lining (endometrium) and increase the risk of endometrial hyperplasia. Over time, this condition can progress to endometrial cancer if left untreated.

3. Gestational diabetes: Pregnant people with PCOS have a higher risk of developing gestational diabetes, a condition characterised by high blood sugar levels during pregnancy. This risk is primarily attributed to the insulin resistance seen in PCOS.

4. Adrenal hyperplasia: Although not directly linked to PCOS, adrenal hyperplasia is another hormonal disorder that affects the adrenal glands. It can sometimes coexist with PCOS, and both conditions can exacerbate each other's symptoms. Adrenal hyperplasia involves excessive production of androgens (male hormones) by the adrenal glands, leading to symptoms similar to PCOS.

5. Glucose intolerance and insulin sensitivity: Insulin resistance is a hallmark of PCOS, meaning that the body's cells do not respond properly to insulin, leading to elevated blood sugar levels. This condition increases the risk of developing glucose intolerance, which can progress to pre-diabetes and type 2 diabetes. Insulin resistance can also contribute to weight gain and difficulty losing weight.

It is important to note that not all individuals with PCOS will experience all of these risks. The severity and manifestation of these complications can vary from person to person. It is recommended that individuals with PCOS work closely with their healthcare providers to manage their condition and minimise these risks through lifestyle modifications, medication, and regular health screenings.

The treatments for PCOS

There are many different options for treatment that people diagnosed with PCOS can explore.

For those who do not want to become pregnant, treating PCOS often involves taking hormonal birth control to manage the symptoms of PCOS, like painful periods, acne, and excessive hair growth. Birth control pills, the patch, and the ring work by preventing ovulation which reduces the number of cysts on the ovary. Birth control pills and other hormonal birth control can also help with menstrual irregularity and hormonal imbalance as well. Some patients also find laser hair removal to be helpful in managing unwanted hair growth.

Maintaining a healthy diet can also help reduce the risk of heart disease associated with PCOS, regulate blood glucose levels, help with weight loss, and other risk factors that can lead to long-term health problems. Weight loss for PCOS patients varies for each individual and if you have specific concerns or questions, talk with your healthcare provider for the best options for treatment.

Long-term, untreated obstructive sleep apnea can contribute to a range of health problems, including type 2 diabetes. If experiencing sleep apnea or any sleep-related symptoms, check in with your healthcare provider about treatment options such as a CPAP machine or lifestyle changes.

It's important to consult with a healthcare professional if you suspect you may have PCOS. They will be able to evaluate your symptoms, perform the necessary tests, and provide an accurate diagnosis to avoid long-term health risks. Working closely with your healthcare provider, Fertifa doctor, or endometriosis specialist will help you develop a personalised plan that suits your specific needs and circumstances. If you have any questions about anything in this article speak with your Fertifa Patient Advisor. We are always here to help 💜