A Guide to how Polycystic Ovary Syndrome (PCOS) is Diagnosed

Polycystic Ovary Syndrome (PCOS) is an endocrine condition that affects 1.55 million women of reproductive age globally. Unfortunately, some go undiagnosed as symptoms differ and investigative procedures are considered on a case-by-case basis. It is, therefore, important to get a diagnosis on the onset of experiencing irregular periods and related symptoms listed further in this blog so that treatment and the inhibition of further complications can begin.

This blog will explore how PCOS is generally diagnosed and what this means for you.

Tests to diagnose PCOS

Transvaginal or Transabdominal Ultrasound

The sound waves from transvaginal and transabdominal ultrasounds create a picture on a video monitor of your bladder, cervix, uterus, fallopian tubes, and ovaries. A transvaginal ultrasound is the gold standard test for PCOS as it allows for clearer visualization of ovarian structures than the transabdominal method. A transabdominal ultrasound can be used for patients who are not sexually active or do not consent to a transvaginal examination. This non-invasive method requires you to have a bladder full of water (at least 1.5L) so that the imaging can be clearer. Your healthcare provider will refer you for one of these tests to determine whether there are any abnormalities present in the ovaries, in particular, cysts.

Both methods are generally painless and safe tests to detect ovarian cysts. They can also determine whether you have any other health issues.

An ovary with multiple cysts is usually described as 'a string or pearls' as the cysts are usually situated around the parameter of the ovaries.

Blood Tests

Your healthcare provider may refer you for blood tests to measure your levels of the following hormones:

• Testosterone is usually classed as a ‘male hormone’, although all women usually produce small amounts of it. In women with PCOS, this may be higher than normal.

• Estrogens are a group of hormones that allow women to have periods. Women with PCOS may have estrogen dominance, meaning the levels may be higher.

• Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH). LH encourages ovulation. It could be higher than normal. FSH affects your ability to get pregnant. If you have PCOS, your level of this hormone may be lower than normal. Usually, in healthy women, the LH and FSH ratio usually lies between 1 and 2. In women with PCOS, this ratio becomes reversed, and it might reach as high as 2 or 3. Because of the raised LH/FSH ratio, ovulation does not occur.

• Sex hormone binding globulin (SHBG) is a protein in the blood that binds to testosterone and reduces its effect. In women with PCOS, this may be lower than normal.

• Human chorionic gonadotropin (hCG) is a hormone test that detects pregnancy, sometimes used to ensure you are not experiencing symptoms due to being pregnant.

• Anti-Mullerian hormone (AMH) can check how well your ovaries are working and can provide an estimate of when menopause may occur. In women with PCOS, the levels may be higher.

Your healthcare provider may recommend a few more tests to rule out other conditions such as thyroid problems, tumours, and hyperplasia (organ swelling due to too many cells) that have similar symptoms to PCOS. Serum insulin levels may also be measured.

Observing Physical Characteristics

Your healthcare provider may check your weight, BMI, waist size and blood pressure. Women with PCOS sometimes appear overweight, with excess abdominal fat. Your healthcare provider may also observe your physical appearance and ask questions in relation to the following:

• Acne

• Excessive facial and/or body hair, particularly on the jawline, chest, back and abdomen

• Male-pattern balding or hair thinning

• Irregular menstrual cycles

Family History

Your healthcare provider may ask about your family’s medical history, with a particular interest in whether any members do or have had diabetes, as studies have shown that PCOS can be largely linked to a genetic trace of this.

Criteria to diagnose PCOS

After undergoing the above examinations, a diagnosis of PCOS can usually 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:

• Blood tests showing you have high or low levels of the hormones above, particularly testosterone.

• You have infrequent or irregular periods, usually indicating anovulation, which is the lack or absence of ovulation (the release of an egg).

• Scans showing you have multiple cysts on your ovaries (polycystic ovaries).

Other conditions associated with PCOS

As noted, the symptoms of PCOS can range from mild to severe. Early diagnosis is key to reducing the risk of long-term complications. Women with PCOS also have increased risks of Type 2 diabetes, hypertension, and other cardiovascular conditions. Other related conditions include insulin resistance, which affects the ovaries, and excessive androgen production. The overproduction of testosterone leads to insulin resistance, which increases the risk of diabetes. Women with insulin resistance also have a higher risk of cardiovascular disease. Furthermore, women with PCOS can sometimes be at risk of obesity, which has been linked to increased androgen levels. In addition to these symptoms, women with PCOS usually experience sleep apnea, depression and anxiety, due to the imbalance of hormones and other physical changes having an effect on their mental state.

I have been diagnosed with PCOS, what happens next?

If you have been diagnosed with PCOS, your healthcare provider will discuss with you the best way to manage your symptoms. They will recommend lifestyle changes such as diet and fitness and may start you on any necessary medicine. You may also be referred to either a gynaecologist (a specialist in treating conditions of the female reproductive system) or an endocrinologist (a specialist in treating hormone problems).

Depending on factors such as your age and weight, you may be offered additional annual checks of your blood pressure and screening for diabetes.

It is important to remember that you are not alone. There are many others in the same position and there are resources available to help you manage your symptoms. Talk to a medical professional about your treatment options and consider joining a support group, such as Polycyster, where you can learn, engage with and receive/provide support to others with PCOS. Polycyster is the ultimate community for the cysters #CFTS!

Coming up

I will speak about how valuable a support network and a symptoms management plan can be to help you control how your body responds to the condition. Subscribe to our blog for more PCOS-related content covering mindfulness, wellness, fitness, nutrition, community and education. Also, keep up with Polycyster via our platforms - www.linktr.ee/polycyster.