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FAQs concerning the diagnosis of PCOS

How should Polycystic Ovary Syndrome (PCOS) be diagnosed?

PCOS should be diagnosed by a credible physician who will begin with a basic physical examination. He/she may also want to have an ultrasound done of your ovaries and require a number of blood tests. Be sure to let your physician know if you are experiencing any of the symptoms of PCOS. There are a number of doctors who feel that a woman must have at least three of the symptoms prior to diagnosing PCOS. Other doctors may make the diagnosis based on the emphasis on lack of ovulation.


How are polycystic ovaries diagnosed by ultrasound?

Ovary ultrasound showing cystic ovaries courtesy of LearningRadiology.com

Ovary ultrasound showing cystic ovaries courtesy of LearningRadiology.com

An ultrasound of the ovaries is usually done by placing a probe into the vagina to view the ovaries. Sometimes, an abdominal ultrasound is done but a transvaginal ultrasound is preferred.

A classic PCOS ovary is enlarged and has a “string of pearls” appearance, where the “pearls” are the cysts. Usually ultrasound diagnosis of polycystic ovaries is made if there are at least 8-10 cysts that are less than 10mm in size on each ovary. The polycystic ovary tends to be enlarged to 1.5-3 times the size of a normal ovary.


Is it possible to have polycystic ovaries without having the syndrome?

Yes. It is estimated that out of 20 to 30% of women, only 5 to 10% will be diagnosed as having Polycystic Ovary Syndrome based on their symptoms. Having cysts on your ovaries is not a definitive criteria to having PCOS. However, a large number of women with ovarian cysts also display other symptoms hormonally of having a predisposition for PCOS.


Is it possible to have PCOS without having cysts?

The medical jury is still out on this subject. Some physicians believe that if a woman is exhibiting a number of PCOS symptoms but do not have cysts, that does not necessary mean that they do not have the syndrome. However, it is difficult to make a firm diagnosis of PCOS without the presence of either an increased number of small cysts or ovarian enlargement. Furthermore, in most cases, if a patient is displaying other symptoms, the likelihood of some ovary irregularities.


PCOS ~ What blood tests to have done

What blood tests should be done to diagnose Polycystic Ovarian Syndrome (PCOS)?

Many doctors will require the following blood tests be done to successfully diagnose Polycystic Ovary Syndrome in a patient:

  • Fasting comprehensive biochemical and lipid panel;
  • 2-hour GTT with insulin levels (also called IGTT);
  • LH:FSH ratio;
  • Total testosterone;
  • DHEAS;
  • SHBG;
  • Androstenedione;
  • Prolactin and
  • TSH

Polycystic Ovary Syndrome

How common is PCOS?

It is currently believed that approximately 5 to 10% of women have Polycystic Ovary Syndrome (PCOS). It is the most common hormonal disorder in women of reproductive years and the leading cause in women for infertility. Since many women can have PCOS without exhibiting any symptoms, the actual number of women affected could be as much as 10% more of the population.


What are the symptoms of PCOS?

Photo of a polycystic ovary courtesy of http://www.ovarian-cysts-pcos.com

Photo of a polycystic ovary courtesy of http://www.ovarian-cysts-pcos.com

Some of the most common symptoms include:

  • Amenorrhea (no menstrual period), infrequent menses, and/or oligomenorrhea (irregular bleeding) Menstrual cycles can often be scant, irregular and infrequent or may also exhibit in the form of spotting throughout the month.
  • Oligo or anovulation (infrequent or absent ovulation) Women with PCOS generally produce an egg but they don’t fully mature. Instead, these immature egg sacs can create ovarian cysts.
  • Hyperandrogenism Women who have PCOS generally also have an increase in serum levels of male hormones such as testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS).
  • Infertility
  • Cystic ovaries Classic PCOS ovaries have a “string of pearls” or “pearl necklace” appearance with many cysts.
  • Enlarged ovaries Polycystic ovaries are usually 1.5 to 3 times larger than normal.
  • Chronic pelvic pain
  • Obesity or weight gain Most commonly referred to as an “apple figure”. PCOS women will generally gain weight primarily in the abdomen and waistline.
  • Insulin resistance, hyperinsulinemia, and diabetes Insulin resistance is a condition where the body’s use of insulin is inefficient.
  • Hirsutism (excess hair) Excess hair growth such as on the face, chest, abdomen, thumbs, or toes.
  • Alopecia (female-pattern baldness or thinning hair) The thinning most commonly occurs on the top of the head.
  • Acne/Oily Skin/Seborrhea
  • Acrochordons (skin tags)


What causes PCOS?

The exact cause of PCOS is unknown. However, there are studies that may lead us to believe that there may be a genetic link. Just as one may have a genetic predisposition to diabetes, one might also have a disposition to PCOS.