Diagnosing PCOS can be difficult since a specific test can't be performed nor is there a set list of symptoms that doctors can look for. Each woman’s experience of PCOS is unique because no two women have the exact same symptoms. However, a diagnosis is usually made when a woman has irregular or absent periods, in addition to signs of hyperandrogenism without another medical cause. When a woman has infrequent, absent or irregular periods, it is a sign that ovulation may not be occurring. The doctor will try to rule out other conditions that could cause irregular periods, such as thyroid disease, hyperprolactinemia, Cushings syndrome or congenital adrenal hyperplasia.
Physical Exam
The doctor will want to do a complete physical and
pelvic exam. He will look for physical signs of
PCOS like abnormal hair growth (specifically on the
face, lower abdomen, back and chest), acne, skin tags,
male pattern baldness and acanthosis nigricans
(darkened thick skin on the neck, thighs, armpits or
vulva). The doctor will ask you about any unusual symptoms
you may have noticed, so make sure to mention any of
your concerns. Writing a list before you go may help
you remember important points to ask about. You will
be asked about your menstrual periods; how regular
they are and the length of time between them. This may help your doctor determine if you are ovulating.
Transvaginal Ultrasound
A transvaginal ultrasound may be performed. An
ultrasound probe is placed inside the vagina, which
allows the physician to examine the reproductive
organs and look for abnormalities. The thickness of
the endometrium can be measured. According to Jensen and Alvaro, “The revised
Rotterdam criteria now define PCOS with findings of 12
or more small (2 to 9 mm) follicles in each ovary.” However, in the United
States, physicians do not typically rely solely on
that definition in order to make a diagnosis. There
are many women who have cystic ovaries without
symptoms of hyperandrogenism, and many women who have
been diagnosed with PCOS who do not have classically
cystic ovaries.
Labs
Finally, blood work will most likely be taken. Here
is a list of the possible tests that may be run.
- LH/FSH
Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) are produced by the pituitary in response to the presence of another hormone. FSH stimulates the growth of an egg follicle within the ovary, while LH causes the release of estrogen from the egg follicle, and ovulation. Both typically ‘surge,’ elevating lab values, just prior to ovulation. Previous diagnoses were made based on a LH to FSH ratio of greater then 3:1. This is not the case anymore because while many women with PCOS have persistently elevated LH levels throughout their entire cycle, it is not uncommon for women to have normal hormone values. If FSH is elevated, it can be an indication of decreased ovarian reserve, or aging/menopause.
- Testosterone/DHEA
Dehydroepiandrosterone (DHEA) and testosterone are two of the androgens, or male hormones. Testosterone is converted from DHEA in either fatty tissue or the adrenal gland. These androgens are responsible for many of the male secondary sex characteristics like abnormal hair growth or loss and acne, which explains the symptoms that PCOS sufferers experience. They also cause menstrual irregularities in women. Elevations of testosterone is typical in women with PCOS. A high DHEA level would indicate an adrenal cause, like Congenital Adrenal Hyperplasia or an adrenocortical tumor, for the patient’s symptoms.
- Thyroid function
These tests are used to rule out thyroid dysfunction as a cause of irregular periods. Thyroid Stimulating Hormone (TSH) is also secreted by the pituitary and controls the release of the two thyroid hormones T3 and T4. These two hormones control basic metabolism and could produce similar symptoms. Either higher or lower then normal lab values could indicate thyroid disease and should be followed up.
- Prolactin
Secreted by the pituitary, this hormone’s primary responsibility is promoting lactation in women. Elevated values can cause amenorrhea, so this test is usually performed to look for another source of irregular periods. If elevated, your doctor will order more tests (usually an MRI or other blood tests) to figure out why it is high.
- GTT
This test will allow your physician to measure your response to a sugar stimulus. Insulin is the major hormone which deals with sugar and fuel within the body. You will drink a sweet, sugary solution. Blood tests will be drawn before the test begins, an hour after you drink the solution, and again at two and three hours afterwards. While not common, your doctor may also request that blood be drawn at different intervals in addition to the standard ones listed above. It is important to not eat or drink anything once the test begins, or for 12 hours before as it will affect the results. Normally, blood sugar should return to normal within 3 hours. If blood sugar levels are elevated beyond the test, or if glucose is detected in the urine, it may indicate that your body does not respond as quickly to insulin. putting you at risk for developing diabetes.
- Cholesterol
Women with PCOS typically have high cholesterol. Because of the association of PCOS with metabolic disturbances, including heart disease and diabetes, it is important to monitor your cholesterol and blood pressure. This will allow your practitioner to quickly treat you if you develop risk factors for cardiac disease and minimize their effects.
