Polycystic ovarian syndrome (PCOS) is the most common hormone problem among women in the fertile age group, and accounts for a significant proportion of visits to a fertility doctor like myself. It’s frustrating especially when they are trying to get pregnant.
In fact 6-8% of women worldwide are affected with PCOS, so don’t think you’re the only person in the world with this, there are many others.
Other names for it are Syndrome X, and Metabolic Syndrome.
It is characterized by increased male hormones in the bloodstream, causing menstrual problems and skin problems, and the ovaries have multiple tiny cysts which are a result of immature follicles that did not grow and release an egg
Here are some of the following features below that you may have as a consequence.
- Menstrual cycle disturbances such as irregular periods
- Acne
- Scalp hair thinning called alopecia
- Increased hair growth on the face and body
- Darkening/ called pigmentation of the skin around the neck. Called acanthosis nigricans
- Skin tags
- Difficulty losing weight
- Difficulty getting pregnant
The above features of PCOS are many, but the classic picture is a young woman who is overweight, does not have a regular monthly menstrual cycle but instead has irregular periods say every 3 or 4 months. When the periods come they are often very heavy.
She may also describe having increased acne on her face, and has noticed increased hair growth on the chin and upper lip which can be embarrassing.
But there can be other presentations.
The above clinical picture can also occur in a slim woman. There are women with PCOS who may only have severe acne and an ultrasound shows a polycystic appearance of the ovaries.
Other clinical scenarios might be PCOS women who have only erratic infrequent periods plus and an ultrasound showing polycystic ovaries or women with infrequent or no menstrual cycle, but have great skin we would all die for, and a blood test showing raised male hormones.
Over the past 30 years doctors and scientists have been debating about what the definition of this condition should be as it has such varying features. Now since 2003 in a conference in Rotterdam a new definition has been decided to give uniformity and lessen ambiguity, and it goes basically like this.
There are 3 criteria in the PCOS definition
- Your blood test confirms the presence of increased male hormones we call Androgens.
- You show clinical signs of increased male hormones – this means having signs such as acne, or increased hair growth on your face or body called hirsuitism.
- You have infrequent or no periods( i.e. menstrual bleeding), this indicates infrequent ovulation (releasing of the egg from your ovary)
- You have a pelvic ultrasound showing at least one ovary to have many small cysts. It has to be 12 or greater cysts
Now for you to have the diagnosis of PCOS – you need to have 2 of the above 3 criteria.
So how do you know if you really have this condition?
Well you would need to see your doctor or specialist for the diagnosis. They would listen to your story and ask specific questions related to your menstrual cycle and skin condition. They would also want to know if you were trying to get pregnant.
They may ask questions related to your family history, is there any one else with the same problem?
The doctor would organize further tests, and these are:
- A pelvic ultrasound looking specifically at the appearance of your ovaries to see if they had the classic cystic picture.
- A blood test to check hormones from your brain and ovaries
- Brain hormones: LH luteinising hormone, FSH follicle stimulating hormone
- Ovarian hormones: estradiol an estrogen
- Male hormones produced by the ovary: Testosterone, Androstenedione and free androgen index to see if they were raised above the normal levels.
- Associated tests with the insulin receptor and weight/BMI