Polycystic ovarian syndrome (PCOS), also known as polycystic ovarian disease (PCOD) or Stein-Leventhal syndrome, is one of the common causes of infertility. It affects about 1 in 10 women in the United States and while not every women will experience difficulty in falling pregnant, early diagnosis and treatment can reduce the chances of infertility at a later stage. A large number cases of PCOS are only diagnosed when a woman seeks medical attention for difficulty in conceiving. However, early recognition of the signs and symptoms by the patient and an understanding of the diagnostic criteria on the part of the practitioner can drastically change the outlook.
Who gets PCOS?
PCOS is a condition characterized by excess male hormones (androgens), irregular menstrual patterns and the development of cysts on the ovaries. Any young girl or woman can develop PCOS but those that are at a greater risk often have a family history of PCOS – a mother, sibling or even a female cousin or aunt. However, women with a family history should not assume that they will definitely develop PCOS and there should be vigilance in taking note of the characteristic features. This includes :
- Menstrual irregularity particularly infrequent or irregular periods (oligomenorrhea) or sudden cessation of periods for more than 3 months (amenorrhea).
- Painful periods (dysmenorrhea).
- Abnormal hair growth on the face, chest or back (hirsutism).
- Difficulty falling pregnant or inability to conceive (infertility).
It is possible that several or even all of these clinical features could be due to other gynecological, endocrine or systemic disorders. PCOS should not be assumed immediately and further clarification is necessary from a doctor.
Apart from family history, women with other disorders may also be at risk of developing PCOS. This includes women who are obese, those who have diabetes mellitus, dysfunction of the pituitary gland or adrenal insufficiency.
How is PCOS diagnosed?
In order to diagnose PCOS, your doctor will take a thorough medical history and perform investigative tests like an ultrasound and blood tests. Two out of the three diagnostic criteria need to be met and other conditions that may cause similar signs and symptoms to PCOS need to be excluded.
The 3 diagnostic criteria include menstrual disturbances, ovarian features evident on ultrasound and an excess of androgens.
- Oligomenorrhea or amenorrhea.
- Ovulation may be infrequent (oligo-ovulation) or absent (anovulation).
- Twelve or more cysts in at least one ovary which measures at least 2 millimeters or more. *
- Enlarged ovary with the total ovarian volume increased to exceed 10 cm3.
* Ovarian cysts are not present in case of PCOS.
Excess of Androgens
An abnormally high level of androgens (male hormones) may be confirmed either through the presence of certain clinical features or with the results of blood tests.
Signs of excessive levels of androgens (hyperandrogenism) may present with hirsutism, androgenic alopecia (female-pattern baldness) and acne. With very high levels, which are rare, there may even be the development of some secondary sexual characteristics of males which is then referred to as virilism.
Elevated levels of androgens in the blood is known as hyperandrogenemia. It may reveal several abnormalities including elevated free testosterone, normal or slightly elevated dehydroepiandrosterone-sulfate (DHEA-S) and/or low levels of sex hormone–binding globulin (SHBG).