Diagnosing PCOS

Diagnosing PCOS

When there are a number of symptoms presented by women with PCOS, not every woman with PCOS will have the same set of symptoms

The Rotterdam Consensus came out with the diagnosis of polycystic ovary syndrome which consisted of selecting either two out of the following three abnormalities:

  1. Enlarged ovaries are present on the ultrasound
  2. High levels of male hormones are in the blood (hyperandrogenism), or symptoms suggesting an excess of male hormones are present (e.g. excessive hair growth, acne)
  3. Menstrual dysfunction (e.g. lack of menses (menstrual flow), menstrual irregularity or lack of ovulation)

Testing for PCOS

Below are some of the tests your health practitioner may recommend in testing for PCOS and excluding other conditions. Please note: not all tests are necessary in every woman.

Medical examination

A thorough medical history and examination, including weight and BMI

Ultrasound

A transvaginal ultrasound (inserting a ultrasound sensor in a pen–shaped probe into the vagina) to get the scan of the pelvis, uterus and the ovaries or an abdominal ultrasound scan (to view ovaries through the tummy wall) is usually done as determined by the physician.

Using ultrasound imaging, the criteria for a polycystic ovaries as compared to polycystic ovary syndrome is the presence of twelve or more follicles in each ovary measuring 2-9 mm in diameter.

With either increased ovarian volume of greater than 10 ml, consistent with the presence of polycystic ovaries in either one or two ovaries is sufficient to make the diagnosis. These ultrasound imaging diagnosis do not pertain to individuals using oral contraceptives because the ovaries are smaller on oral contraceptives.

While women with PCOS can have enlarged ovaries, many of them think they may have a lot of cysts on their ovaries. But, they are not cysts and they actually have many small immature follicles that causes the ovary size to be large.

Blood tests

Hormonal blood tests such as:

Blood tests for androgens (testosterone) and FAI (free androgen index) are the best tests for diagnosing the presence of excess androgen. Other blood test methods that can be useful in diagnosing excess androgen include sex hormone binding-globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS) and androstenedione.

Blood tests for other reproductive hormones e.g. oestradiol, follicle stimulating hormone (FSH) and Luteinizing Hormone (LH).

Blood tests to exclude other conditions which can mimic PCOS symptoms.

These include measurement of thyroid stimulating hormone (TSH), prolactin levels and hormones related to adrenal function (e.g. 17-hydroxyprogesterone).

Assessing risk factors for cardiovascular disease and diabetes are important in PCOS and especially in overweight women.

This includes blood tests for cholesterol, blood pressure and blood tests for glucose metabolism (glucose tolerance tests). Women with PCOS should have their cholesterol levels measured every two years, their blood pressure measured every year and have a glucose tolerance test at-least once in every two years. If a woman with PCOS is overweight or gaining weight or has other risk factors such as abnormal lipid levels, a history of diabetes in pregnancy or a family health history of diabetes then the above mentioned tests should be done more frequently depending on the individual.

If you suspect you may have PCOS, you will need to visit your Family Physician or General Practitioner and undertake the appropriate investigations. Women diagnosed of possible PCOS, are usually suggested to see an Endocrinologist and attend education and lifestyle management sessions and be referred on to additional specialists as required.