How is PCOS (polycystic ovary syndrome) diagnosed?

How is PCOS diagnosed?

Many women who suspect they have PCOS feel they don’t need to worry about it until they are ready to start having children. Truth is, the sooner you understand the type of PCOS you have and how best to manage your symptoms the easier things will be for you when you are trying to fall pregnant. Managing your symptoms is also important for reducing your risk of other conditions linked to PCOS.

If you have any symptoms of PCOS it is important that you get an official diagnosis, as this will help you manage your symptoms going forward.

As a reminder not everyone will have all the symptoms, the most common symptoms of PCOS include: hirsutism (excessive hair growth), acne, difficulty losing weight or unexplained weight gain, irregular or absent periods (typically menstrual cycles that are shorter than 21 days and longer than 35 days) and alopecia (hair loss).

The most widely accepted diagnostic criteria are the 2003 Rotterdam criteria, it states that women need to have two of the following three:

  1. Hyperandrogenism (increased androgens):

This includes hirsutism (excessive hair growth appearing in a male pattern e.g. around the chin) and acne. It can be diagnosed on clinical appearance or through testing serum androgen levels or both.

  1. Ovulatory Dysfunction:

This is typically defined as a menstrual cycle that is shorter than 21 days or longer than 35 days. It is important to note that regular periods every 21-35 days do not indicate normal ovulation in women with hyperandrogenism (increased androgen levels). Around 15-20% of women with hyperandrogenism and regular periods suffer with ovulatory dysfunction.

  1. Polycystic ovaries:

This is currently defined as 12 or more follicles (2 to 9mm in diameter) in either ovary, ovarian volume greater that 10ml in either ovary, or both.

As part of your diagnosis it is important that your GP rules out any of the following: late-onset congenital adrenal hyperplasia, Cushing’s syndrome, or an androgen-secreting tumour. It is also recommended that the following tests are carried to assist in diagnosis:

  • Total testosterone
  • Prolactin
  • Luteinizing Hormone and follicle stimulating hormone (LH & FSH)
  • Sex hormone-binding globulin
  • Thyroid stimulating hormone

Getting an official diagnosis is not always easy, unfortunately not all GP’s are up to date with the latest research around PCOS. If your GP does not see the need to test the above, then I encourage you to see another GP who is slightly more up to date on PCOS.

 

 

References:
Azziz R, Carmina E, Chen Z, et al. (2016) Polycystic ovary syndrome. Nature Reviews Disease Primers;2.
Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). (2004) Human Reproduction; 19:41–7.
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