Irregular periods or no periods at all, excess hair growth (hirsutism), acne, obesity and difficulty losing weight, thinning hair and male pattern baldness, pelvic pain or feeling of pressure, infertility are some common signs and symptoms seen in women with polycystic ovary syndrome (PCOS). However, not every woman experiences all symptoms. The signs and symptoms may vary from mild to severe.
PCOS Diagnostic
Due to the diverse nature of PCOS symptoms, diagnosing the syndrome can be a challenge for both patients and physicians. The diagnosis of PCOS is based on the following criteria set by the Rotterdam ESHRE/ASRM–Sponsored PCOS consensus workshop group:
- Raised androgen levels - high levels of male hormones like testosterone and androstenedione are found. Blood tests are done to check hormone levels.
- Irregular periods or absence of menstrual cycles - this is due to hormonal imbalance where the ovaries do not regularly release eggs each month.
- Polycystic ovaries on ultrasound scan - the ovaries contain a string of small collections of fluid (follicles) and do not regularly release eggs each month. An ultrasound is performed to check for cysts (fluid-filled sacs) in the ovaries.
- If a woman has at least two of the above three criteria, she fulfills the clinical definition for a diagnosis of PCOS. All three criteria do not need to be present.
PCOS Diagnostic: Ruling Out Other Conditions
Since PCOS shares symptoms with other hormonal disorders, a diagnosis of exclusion is very important. Tests are done to rule out:
- Congenital adrenal hyperplasia (CAH) - a genetic disorder affecting the adrenal gland which can cause similar symptoms. Blood and urine tests are done to check for CAH.
- Hyperprolactinemia - a condition characterized by excessive levels of prolactin hormone which can disrupt menstrual cycles. A blood test checks prolactin levels.
- Thyroid disorders like hypothyroidism - an underactive thyroid gland can mimic PCOS signs. A simple blood test checks thyroid levels.
- Pituitary gland disorders - non-cancerous tumors or other issues affecting the pituitary gland regulating hormones can present as PCOS. An MRI is considered.
- Cushing's syndrome - high levels of cortisol hormone due to tumors in adrenal or pituitary gland cause weight gain seen in PCOS. Tests differentiate between PCOS and Cushing's.
Making a confirmed diagnosis and eliminating other differential diagnoses is important to plan an effective treatment approach tailored to the patient's needs. Lifestyle modifications and medication help manages PCOS symptoms and related health risks. Regular follow-ups allow monitoring treatment progress.
PCOS Diagnostic in Adolescents
PCOS is also being increasingly diagnosed in adolescent girls, especially those who present with irregular periods and excess body hair growth. However, diagnosing PCOS in teenagers can be tricky due to ongoing hormonal changes at this age. The diagnostic criteria for adolescents are:
- Clinical or biochemical signs of hyperandrogenism like acne or hirsutism
- Menstrual irregularity - six or less menstrual cycles in the preceding year
- Polycystic ovaries found on ultrasound
The key difference is absence of menstrual cycles alone is not sufficient for diagnosis in teenagers as periods may still be regulating. Presence of cystic ovaries and clinical signs of androgen excess along with irregular bleeding patterns help confirm PCOS in adolescents. Lifestyle changes remain the first-line approach for young patients.
Conclusion
While PCOS presents with a heterogenous range of symptoms, carefully evaluating hormone levels, ultrasound findings and menstrual history along with ruling out similar conditions provides a clear diagnostic picture in most cases. Making a well informed diagnosis helps recommend appropriate individualized treatment plans for better symptom relief and long term health management. Regular follow-ups ensure any changes can be addressed promptly.
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