PCOS Diagnosis
Medically Reviewed by Dr Sravya, MBBS, MS
What IS PCOS?
PCOS is one of the most common diseases women suffer from nowadays. The PCOS diagnosis can be a shocker for you. But let us tell you that the disease is controllable. The diagnosis of PCOS is based on hyperandrogenism in the absence of adrenal diseases.
The diagnosis of PCOS plays a major role in the effective management and treatment of the disorder. By understanding the diagnosis of PCOS in detail, healthcare providers can prescribe treatment plans for the symptoms shown by a person.
PCOS is a condition in which hormonal imbalance is seen in the reproductive years. A woman with PCOS may have irregular or absent periods. An increase in androgen hormone is seen in the body.
In PCOS, many small sacs of fluid are seen in the form of cysts on the ovaries. The exact cause is unknown, but early PCOS diagnosis and proper treatment with weight control programs will help reduce long-term complications like cardiovascular disease and type 2 diabetes.
High levels of androgens interfere with the development of ovarian follicles, which produce the hormones estrogen and progesterone and release eggs when women ovulate. this, Due to which multiple follicles are seen in the form of cysts on the ovaries, which is known as polycystic ovaries.
Insulin production is not effective in women with PCOS, leading to an increase in blood sugar levels in the body, which leads to Type 2 diabetes if the blood sugar level is left untreated.
Women with PCOS are also at risk of endometrial hyperplasia (thickening of the uterine lining), uterine cancer, preterm delivery, and preeclampsia, in which there is high blood pressure during pregnancy. They also have the chance of miscarriage.
Who gets polycystic ovarian syndrome?
5%–10% of women in the age group of 15–44 years, or during the age when you can have children, have PCOS. Most women find out they have PCOS in their 20s or 30s when they have problems getting pregnant. PCOS can affect any age of puberty.
Women of all races and ethnicities are at risk of PCOS. The risk of PCOS is higher in women with obesity or if your mother, sister, or aunt are having PCOS symptoms.
Table of contents
- Symptoms of PCOS
- Causes of PCOS
- Diagnostic criteria for PCOS
- Diagnostic test for PCOS
How is PCOS affecting women's lives?
Being aware of the impact of PCOS, it is necessary to improve the quality of life, control symptoms with the proper medications prescribed, and live a healthy life.
- Irregular periods:Irregular periods are the first sign of PCOS, which occurs due to hormonal imbalances that disturb the normal ovulation cycle.
- Abnormal hair growth:Due to an increase in androgen levels in the body, abnormal hair growth is seen in areas like the chin, face, chest, and thighs. Thinning of scalp hair is also seen, leading to excessive hair fall.
- Presence of acne:Acne is seen on the face, chest, and back due to hormonal imbalances in the body.
- Increase in body weight:Due to insulin resistance in the body, there is an increase in body weight.
- Difficulty to conceive:Because of irregular periods and a lack of ovulation, women find it difficult to get pregnant. Infertility is a common sign of PCOS.
Causes of PCOS
The exact cause of PCOS is not known, but having a genetic or family history will be one cause of PCOS. PCOS is also related to hormonal imbalances in the body during the reproductive phase.
- Genetic and family history:For women with a genetic or family history of PCOS, there are increased chances of PCOS in related women.
- Hormones : In PCOS, an increased level of insulin is seen, due to which the ovaries work differently, leading to increased levels of androgen in the body, which causes irregular periods. If the hormone level in the body is controlled, the symptoms will decrease.
- Insulin resistance: The majority of women with PCOS are insulin-resistant. If there is insulin resistance. The body blocks glucose from going into the cell. This leads to a higher insulin level in the body. to which there is an inverse in androgen production in the ovaries.
- Body weight : PCOS may affect women of all weights. The heavier the body weight, the higher the risk of hormones responsible for PCOS symptoms. Weight reduction helps reduce the hormonal level in the body and helps improve the symptoms of PCOS.
How is PCOS diagnosis carried out?
The health care provider does the PCOS diagnosis test based on the symptoms shown by the women. Blood tests and ultrasounds can also be done.
Your healthcare provider will:
- Communicate with you to have the symptoms explained and a medical examination done.
- Ask about any family history present.
- Record your weight and blood pressure.
- Do a physical examination to look for facial hair in excess, hair loss, acne, discolored skin, and skin tags.
- Do a pelvic examination if any abnormal bleeding is present.
- Do a blood test to check hormonal levels in the body.
- Do a pelvic ultrasound to look at the ovaries, the thickness of the uterine lining, and any abnormal bleeding present.
What are the diagnostic criteria for PCOS?
PCOS is diagnosed if you have any of the following symptoms:
- Irregular periods or no periods
- Blood tests detect high androgen levels in the body.
- Ultrasound scan to detect cysts on the ovaries seen in PCOS women
NOTE: An ultrasound scan is not recommended if the woman is younger than 20 years of age.
What are the diagnostic tests for PCOS?
1. BLOOD TEST FOR PCOS
Blood test for testosterone and androgen-free index( AFI) to check the level of androgen in the body.
Blood tests check other hormonal levels in the body concerning ovulation, such as FSH, LH, and progesterone, which help to indicate whether the woman is ovulating.
FSH/LH blood test:
Follicle-stimulating hormone (FSH) helps to stimulate the growth of the egg follicle within the ovary while luteinizing hormone (LH) helps to release the egg during ovulation. Many women with PCOS have elevated LH levels throughout the menstrual cycle.
If your FSH is also elevated, it is an indication of primary ovarian insufficiency.
Testosterone blood test:
Testosterone and dehydroepiandrosterone (DHEA) are called androgens. A rise in testosterone and DHEA levels leads to symptoms like abnormal facial and body hair and acne in women. Androgen irregularities help in the diagnosis of PCOS.
Estrogen level test:
Abnormal estrogen levels are common in PCOS. In women with PCOS, higher estrogen levels are caused by the conversion of insulin and testosterone into estradiol, a form of estrogen
Sex hormone-binding globulin (SHBG): It may be lower than the normal range present. Androstenedione is a sex hormone, which may be higher than normal.
Pregnancy test: Pregnancy is the common cause of not getting periods. A doctor will evaluate you by doing a pregnancy test, which measures the human chorionic gonadotropin hormone present in the urine.
Anti-Mullerian hormone (AMH) test: High levels of AMH hormones are a sign of PCOS. It inhibits the follicle’s ability to mature into the egg, which prevents further ovulation and longer menstrual cycles, which can lead to infertility. A doctor may also check for hypothyroidism, which leads to depression and fatigue
Women who are on any contraceptive pills need to stop the pills three months before the blood test to check the hormone level in the body
To assess the risk of developing heart disease and type 2 diabetes mellitus, a doctor may recommend doing tests like –
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- The lipid profile test measures your cholesterol and triglyceride levels in the body. Heart disease is likely to develop in PCOS women.
- Glucose tolerance blood test to check for diabetes. The majority of women with PCOS also have diabetes.
- Insulin: To control the blood sugar level in the body, the insulin level is checked. If the body doesn’t respond to insulin, it may show insulin resistance. Commonly seen in PCOS women, leading to diabetes.
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A woman with PCOS is suggested to do a lipid profile, blood pressure test, and glucose tolerance test every year. If you are planning to conceive, the doctor may do more evaluations as needed.
Depending on the age and weight of the woman, an annual checkup of blood pressure and diabetes is done if you are diagnosed with PCOS
2. PELVIC ULTRASOUND FOR PCOS
Your doctor may suggest you do a pelvic ultrasound, in which sound waves are used to create images of the uterus and the ovaries on a computer monitor screen, to check for any ovarian cysts present. Women with PCOS who are on birth control pills may not show the presence of ovarian cysts, if any.
Doctors may recommend a few tests to find out if there are any tumors or hyperplasia (organ swelling due to many cells) if any are seen.
With proper medications prescribed by the doctor, PCOS symptoms can be managed, and you can live a healthy life.
What are the diagnostic criteria for insulin resistance syndrome in women with PCOS?
Any three or more of the following symptoms below:
- Waist circumference > 88 cm
- triglycerides>150 mg/dl
- HDL cholesterol: 50 mg/dl
- Blood pressure>130/85
- Fasting glucose >110 mg/dl
How do you diagnose PCOS in the teenage years?
It is difficult to diagnose PCOS in the first year after the periods have started in a teenager. During this time, periods are often seen irregularly, but they become regular by the second year.
If this doesn’t happen and your periods are either irregular or absent, it may be due to PCOS. If other symptoms like excess hair growth or acne on the face, chin, or chest are seen, you may be assessed for PCOS.
Conclusion
PCOS is a major threat to women’s health. It also carries considerable long-term risk factors if proper diagnosis and treatment are not done. With the correct diagnostic test and the symptoms explained by the women, the diagnosis of PCOS can be made to reduce further long-term complications.
If the woman with PCOS wants to get pregnant, proper follow-up with the healthcare provider, a diagnostic test done as recommended, and the intake of adequate medications will be helpful.
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