PCOS series (part 2) - how is it diagnosed?


As I discussed in my previous post, diagnosing PCOS can be a really drawn out process for some women. It can be incredibly frustrating - leaving you even more confused about your health. I'll just say this again, because it's important, but having polycystic ovaries on an ultrasound does not always mean you have PCOS. It's normal to have some cysts (actually follicles) on the ovaries at some stage throughout your reproductive years.

Diagnosing PCOS can be a little confusing as there are several different diagnostic criteria used. However, based on the Rotterdam criteria (one of the more commonly used criteria), PCOS is diagnosed when at least two of the following are present (please also speak to your GP or specialist as this is just a guide designed to educate, not to diagnose):


  1. Oligo-anovulation or anovulation - in simple terms this means ovulation is irregular or absent - you may experience long menstrual cycles or skipped periods

  2. Hyperandrogenism - raised androgens (ovarian or adrenal androgens such as testosterone, dihydrotestosterone - DHT or dehydroepiandrosterone sulphate - DHEAS) on a blood test or symptoms of high androgens - including hirsutism (excessive hair growth on the face/chest/stomach), hair loss/thinning & acne

  3. Polycystic ovaries on ultrasound (high number of follicles on the ovaries detected)

Other causes of androgen excess must also be ruled out to confirm this diagnosis.


ISSUES WITH DIAGNOSIS:

I understand that when you're struggling with symptoms it can be relieving (also a little scary) to finally receive a diagnosis, but it's important to make sure this is correct.

A misdiagnosis can send you down an inappropriate and ineffective treatment route - creating more complex issues in the long run. You'll also be ignoring the actual cause of your symptoms, which can exacerbate your health concerns as they aren't being treated. If you do not fit this criteria I discussed, but still have symptoms, look down other avenues and get a second opinion.

It's important to be able to identify other causes of menstrual issues and an-ovulation. One of these conditions includes hypothalamic amenorrhea, which is essentially an issue with the communication between the brain and the ovaries that results in lack of ovulation and amenorrhea (no period). Low body weight, excessive exercise, insufficient calories or carbohydrates and disordered eating can all contribute to this condition.

Additionally, thyroid conditions such as hypothyroidism can also impact the menstrual cycle. This is because the hormone system involving your thyroid is closely related to that of your ovaries, so an imbalance in the thyroid hormones can interfere with hormone production and ovulation - leading to irregular periods or sometimes heavy painful periods.

High stress can also contribute to an-ovulation. There are many other conditions I could discuss, but it's important you chat to your doc/specialist and get the appropriate tests done.

I also think it's necessary to go beyond diagnosing PCOS and look at what's driving the condition for each individual. If you struggle with weight - you may want to look at your insulin and glucose levels for example.. as insulin resistance is a common issue that contributes to PCOS development. If stress is a major issue for you - you may want to look at your DHEAS or cortisol (both adrenal hormones that may be elevated in PCOS). If your gut health is struggling - perhaps looking at food intolerances and the gut microbiome will be helpful to find the appropriate direction for treatment.

In the next post I'll discuss what is actually happening in the body when we have PCOS, followed by the approach I take with patients to manage this condition.