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Diagnosis of PCOS

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Updated June 20, 2009

Diagnosis of 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. Besides hormonal testing, like for testosterone, Follicle Stimulating Hormone, Lutenizing Hormone and prolactin, your doctor may test for other associated conditions like high cholesterol and insulin resistance. A new hormonal blood test, looking at a woman's AMH (Anti-Mullerian Hormone) is now being used by some physicians as a diagnostic tool as well.

Endometrial Biopsy
An endometrial biopsy can be performed to determine if your endometrial tissue is in the correct phase or to test for endometrial cancer. This risk of endometrial cancer increases with the number of and length of time between missed periods. The biopsy can be done in your doctor’s office and is relatively painless, although you may experience minimal cramping during the procedure. A small amount of tissue is removed from your uterus through a thin catheter placed into through the cervix and into the uterus. This tissue is then analyzed in the context of your cycle, and examined for cancer cells.

What's Next?
While this may all seem overwhelming, remember that you are not alone. As the most common endocrine disorder among women of child bearing age, there are many women who have been through this. Reach out to a support group and the people who care about you. Following your doctor's advice and learning about your disease is the best way to manage it.


Next:
Treating PCOS

Sources:

Jensen, Jani R. and Ruben Alvero. "Polycystic Ovarian Syndrome." Reproductive Endocrinology and Infertility: The Requisites in Obstetrics and Gynecology. Ed. Mark Evans, MD. Philadelphia: Mosby, 2007. 65-75.

Pagana, Kathleen Deska and Timothy J. Pagana. Mosby's Manual of Diagnostic and Laboratory Tests. Second Edition. St. Louis: Mosby, 2002.

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