Polycystic ovary syndrome (PCOS) Diagnosis

Polycystic ovary syndrome (PCOS) is a condition that affects approximately 6 to 13% of patients assigned female at birth (AFAB) who are of reproductive age and beyond. This disease affects hormones and fertility, creating imbalances that can cause additional health concerns such as diabetes or metabolic issues. This article provides a brief overview of polycystic ovary syndrome, focusing on diagnostic methods and assessments.

What is PCOS (polycystic ovary syndrome)?

PCOS is a complex disease that can create hormonal imbalances in AFAB patients, often beginning in adolescence though some may not manifest symptoms until later. These imbalances are thought to be due to an excess of androgen hormones. Androgens, often called “male” sex hormones, are found in everyone regardless of sex or gender. However, patients with PCOS often have elevated levels in comparison to expected baselines.

No precise cause of PCOS has yet been determined, but there may be increased risks due to type 2 diabetes or a family history of the disease. Some ways the condition may affect the patient include:

Irregular menstruation: Periods may be irregular, often occurring more or less frequently than is typical.
Polycystic ovaries: PCOS patients may have multiple small fluid-filled sacs called antral follicles. These are not true ovarian cysts, which means the name “polycystic ovary syndrome” is a bit misleading. Antral follicles are a normal part of the ovary, while ovarian cysts are usually larger and can form when something goes wrong with ovulation. PCOS patients may have a higher number of antral follicles than is typical.
Reduced ovulation: Ovulating less often can lead to difficulties in fertility, making PCOS one of the leading causes of infertility. Patients desiring pregnancy may want to seek out fertility specialists with experience in this condition.
Skin changes: The patient may have acne-prone or oily skin. Skin tags and darker patches of skin are also common.
Hair thinning: The patient may have thinning of the hair or male pattern balding.
Weight gain: Because PCOS often causes metabolic issues, there may be weight gain especially around the abdomen.
Body hair growth: The patient may experience body hair or facial hair growth.

It is important to note that the presence of these symptoms does not necessarily mean you have PCOS. There are other conditions that may have similar symptoms or other causes of these issues. It is recommended to discuss any concerns or questions with your medical provider so they can assess you on an individual basis with greater accuracy.

Health conditions linked to polycystic ovary syndrome

Individuals with PCOS are also at a higher risk of experiencing other health conditions, which may necessitate additional treatments or preventative measures to manage patient health. Some of these possible comorbidities include:

High blood pressure: Patients may experience high blood pressure due to complications of PCOS.
Metabolic syndrome: Metabolic syndrome may include obesity and difficulty losing weight, insulin resistance and higher risks of cardiovascular disease. It is estimated that 43% of adult AFAB patients with PCOS also have metabolic syndrome.
Type II diabetes: Over half of PCOS patients develop type II diabetes, which is when their bodies are unable to balance blood sugars due to insulin resistance.
Sleep apnea: Due to higher rates of metabolic syndrome and obesity, some PCOS patients are prone to sleep apnea, where the patient has pauses in breathing while asleep. This can worsen metabolic issues, though there are highly successful apnea therapies that can treat this condition.
Liver issues: Complications from metabolic syndrome and PCOS can lead to non-alcoholic fatty liver disease, which may damage the liver if not treated.

Outlook for PCOS

While there is currently no cure for polycystic ovary syndrome, there are several treatment options to manage symptoms and improve patient health and quality of life. There are also different degrees of severity of the disease, with some patients never going on to develop diabetes or other complications or only experiencing mild PCOS symptoms.

Endocrine specialists who treat hormone disorders can help patients find lifestyle changes and medications to manage or reduce symptoms. Fertility specialists can often help patients who want to undergo pregnancy. Much can be done to help alleviate this disease and assist patients in improving their health.

Diagnosing PCOS

Diagnosing polycystic ovary syndrome often follows what is called the “Rotterdam criteria.” It requires two out of the following three criteria to be met after the exclusion of other possible diagnoses:

Irregular menstruation
Hyperandrogenism (excess androgen hormones)
Polycystic ovaries

The next sections will further review these diagnostic requirements.

Irregular menses

Excess androgen hormones can cause imbalances throughout the body, including irregular menstruation and ovulation. If the patient has irregular menstrual cycles, it could meet one of the diagnostic criteria for PCOS. Some specific clinical guidelines for being categorized as having irregular cycles include:

It’s been over three years since the patient had a cycle
Cycles are over 35 days apart
Cycles are less than 21 days apart
The patient has fewer than 8 periods per year
It’s been over 90 days since one menstrual period

Hyperandrogenism

Hyperandrogenism means excess androgen hormone levels. This could be indicated through physical manifestations such as excess facial or body hair on the patient (called hirsutism), thinning hair, male pattern baldness or acne. Sometimes these symptoms are enough for the physician to suspect PCOS from these factors alone. Blood tests can also be performed to compare the patient’s androgen levels against typical baselines.

Polycystic ovaries

Antral follicles are small fluid-filled sacs containing immature eggs. In regular ovulation, one of these follicles ruptures and releases an egg each month. Because of menstrual irregularities and hormonal imbalances, many PCOS patients have a higher number of these antral follicles than typical, which is where the name “polycystic ovary” comes from. However, it is important to note that these follicles are not actually true ovarian cysts.

In the Rotterdam PCOS criteria, patients are considered likely to have the disease if they have at least 12 follicles, ranging in measurements from 2 to 9 mm. Newer recommendations suggest raising the threshold to 20 or more follicles; however, there is some disagreement in the medical field that this number may be too high and could prevent some PCOS patients from being diagnosed or delay diagnosis.

In terms of assessing follicle count, the usual method is a transvaginal ultrasound for PCOS. Ultrasounds use high-frequency sound waves to create internal images of the body. The waves bounce off internal structures and tissues, returning to form pictures that can be captured and studied. These waves are produced by a wand-like device called a transducer. In a transvaginal ultrasound, this is inserted into the vagina to obtain better positioning for clearer images.

Getting your results

Turnaround times for ultrasound results can vary widely depending on the facility and your doctor’s availability. Often, patients wait a week or more and receive their results during a follow-up appointment. With PocketHealth, you don’t have to wait as long—your results are securely accessible as soon as the imaging or report are available, allowing you to review them often before your follow-up visit.

Your imaging results are interpreted by a radiologist—an expert in medical imaging—who carefully reviews your scans and provides a detailed report of any findings. This report is then sent to your referring doctor, who, with a deeper understanding of your medical history, can offer further insights and recommendations.

To better understand your imaging reports, Report Reader provides clear, straightforward definitions for medical terms. Simply tap or click on any underlined words to reveal their meaning. This is paired with illustrations and highlights of anatomy in your imaging to help you better understand your results and prepare for follow-up appointments.

Frequently asked questions

Here are some frequently asked questions regarding polycystic ovary syndrome.

What are the treatments for PCOS?

There are a variety of possible treatments for PCOS patients. Some may vary depending on whether the patient desires to become pregnant or not, and some may be used in conjunction with each other. Examples of possible treatment methods include:

Weight management: Maintaining a healthy weight can reduce several PCOS symptoms, improve ovulation and menstruation and improve insulin sensitivity.
Anti-androgen medications: These medications can lower androgen levels, which may improve irregular hair growth and acne.
Medications to improve insulin sensitivity: These can help reduce the chance of developing type II diabetes, help control cholesterol levels and improve menstrual regularity.
Hormonal birth control: Birth control may help improve hormone imbalances and PCOS symptoms.
Hair growth and removal treatments: If the patient desires, there are multiple methods to help regrow thinning hair or eliminate unwanted body or facial hair.
Fertility treatments: Medications and techniques, such as in vitro fertilization, may be used to assist PCOS patients with fertility.

Can PCOS be prevented?

Currently, PCOS can’t be prevented. The disease is thought to result from a combination of genetic, lifestyle and environmental factors. Research is ongoing to explore the genetic component, with recent discoveries identifying 19 possible genetic variations that may predispose patients to PCOS. While prevention is not currently possible, patients can manage other aspects of their health to reduce symptoms or control the condition. It’s important to discuss personalized approaches with a qualified health provider or specialist, as individualized treatment may be more effective.

Does PCOS go away with menopause?

Menstrual-related symptoms and issues typically resolve with menopause for PCOS patients. However, the inflammatory response, insulin resistance and other metabolic issues often continue through menopause and beyond.

Can you have PCOS without polycystic ovaries?

Yes, it is possible to have PCOS without having polycystic ovaries or abnormally high numbers of antral follicles. Alternatively, it is also possible to have polycystic ovaries without having PCOS. This is why it’s important for multiple criteria to be met before making an official diagnosis.

Take control of your health journey

PocketHealth makes it simple to keep track of your ultrasound scans. All of your vital imaging is in one secure location and can be accessed online anytime. Imaging and reports can also be easily shared with other physicians in your care team, if needed. Additionally, it makes it easy to track health changes over time, such as with repeat imaging. When used in conjunction with your medical provider’s professional advice, it is a powerful tool for organizing and understanding your imaging results and your health.

PocketHealth MyCare Navigator gives personalized insights into your health and identifies any recommended follow-up steps. This functionality can also generate individualized questions to ask your doctor based on the findings in your report, ensuring you make the most of your consultation. A PCOS diagnosis may feel overwhelming, but working closely with your providers can give you the best chance of managing your condition and protecting your health.