Polycystic Ovarian Syndrome, or PCOS, is a complex endocrine disorder that affects up to one in five women of reproductive age. The syndrome typically manifests with various symptoms, including menstrual irregularities, insulin resistance with weight-gain. There also is excessive production of androgens, or masculinizing hormones, resulting in acne, excessive hair-growth on the face or body, acanthosis nigricans, or dark velvety patches of skin on body folds and joints, and skin tags. According to the Androgen Excess Society, the most current diagnostic criteria for PCOS includes absent or irregular menses, the presence of polycystic ovaries as visualized by ultrasound and an increase in androgens detected either clinically or through blood tests.
PCOS Diagnosis on Birth Control
Assessing clinical signs visually provides vital information indicating PCOS. Such signs include visceral or abdominal fat, hirsutism, acne, acanthosis nigricans, skin tags and male-pattern hair loss or thinning. Though some symptoms are masked or suppressed by oral contraceptives, patients can exhibit symptoms even while using the contraceptive. Weigh yourself and measure your waist circumference. Being overweight and having a waist size of greater than 32 inches are warning signs. Look closely at your face and body in a mirror. Look for superfluous hair growth on the face and body, thinning hair along the forehead, skin tags and dark patches of skin in body folds. Any of these symptoms warrant a visit to your physician and preferably, an endocrinologist.
The use of hormonal contraceptives, while effective in reducing the androgen excess, may not aid in weight-loss or an improvement in insulin sensitivity. Most women with PCOS develop insulin resistance and consequent weight-gain. Such cases can be effectively diagnosed by an oral glucose tolerance test, which shows how quickly the body clears glucose after a sugary drink, notes an article in the journal, "Medical Clinics of North America."
Although the pill alters hormonal biomarkers, an ultrasound could reveal abnormalities in the thickness of the endometrial lining, size and appearance of the ovaries, morphology of ovarian follicles, and can also confirm the presence of cysts. This is usually the conclusive test of the condition, according to the "Journal of Pediatric and Adolescent Gynecology."
Blood tests for dehydroepiandrosterone sulfate, or DHEAS, 17-OH-Progesterone and serum, and free testosterone are useful indicators of PCOS in addition to other PCOS diagnostic measures. Ask your doctor about these tests if you are uncertain.
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Typically, women who present with irregular or absent periods are candidates for further testing to diagnose PCOS. Additionally, women with PCOS suffer weight-gain, acne or hirsutism. Unfortunately, the latter symptoms also exist in women with normal menstrual patterns. These women and their physicians are likely to attribute their symptoms to poor diet, hormonal fluctuations or genetics, rather than PCOS, delaying accurate diagnosis and effective treatment. In many cases, PCOS remains undiagnosed until the patient encounters fertility issues or experiences worsening of symptoms. Yet, because 60 percent of women with PCOS can conceive within 12 months, albeit with an increased conception time, the condition can compromise a pregnancy, or worse, result in adverse outcomes for the patient or fetus.
Since they are highly effective in regulating periods, birth control pills (BCPs) are often the first course of treatment in young women diagnosed with PCOS. BCPs regulate the progesterone-estrogen balance that is often disturbed in women with PCOS and reduce circulating androgens in the body. The restoration of this balance helps manage the clinical symptoms associated with hyperandrogenism, such as acne and hirsutism. Additionally, BCPs inducing regular menstruation reduces the risk for endometrial disease in women with PCOS (Reference 1). However, long-term use could mask the telltale symptoms of the syndrome. Withdrawal of hormonal contraception often results in an exacerbation of symptoms.
Given the symptomatic complexity and possible overlap with hormonal imbalance pathologies, excluding other conditions is paramount. These conditions include disorders of the thyroid gland and endocrine or reproductive organ tumors contributing to symptoms resembling PCOS. Because visual diagnosis and interpretation of PCOS symptoms is complicated, other criteria may be employed if PCOS is suspected. Remember that there is no singular optimal diagnostic test for PCOS.
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- “BMC Medicine”; Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan Teede et al.; 2010
- “Minerva ginecologica”; Best methods for identification and treatment of PCOS;
- “Fertility and Sterility”; High prevalence of polycystic ovary syndrome in women with mild hirsutism and no other significant clinical symptoms; Di Fede, G. et al.; 2010
- “Medical Clinics of North America”; Basic infertility including polycystic ovary syndrome; Brassard M et al.; 2008
- “Journal of Pediatric and Adolescent Gynecology”; Endometrial Thickness, Uterine, and Ovarian Ultrasonographic Features in Adolescents with Polycystic Ovarian Syndrome; Shah, B. et al.; 2010