PCOS: What do you need to know?
What is PCOS?
PCOS stands for polycystic ovarian syndrome. Some women that have PCOS have multiple cysts on their ovaries, but strangely enough, the absence of cysts does not rule out PCOS and the presence does not rule in PCOS. The Rotterdam Criteria for a PCOS diagnosis is as follows:
At least 2 of these 3 (simplified) criteria must be present to diagnose PCOS:
Chronic anovulatory disorder (not regularly ovulating or menstruating)
Clinical symptoms or biochemical signs of hyperandrogenism (such as acne, hair loss or excessive hair growth on specific areas of the body)
Presence of polycystic ovaries on ultrasound
There are a few different types of PCOS and they are classified based on what signs and symptoms an individual has, as there can be a combination of what's seen above. It's important to understand this so that we can target necessary treatment for that individual. Often a physical exam and some bloodwork can help guide our treatment enough, but sometimes an ultrasound is useful, especially if we are trying to rule out other causes of these symptoms.
What are the main symptoms that would prompt an investigation into PCOS?
Irregular menstruation
Missed/absent periods, cycles lasting longer than 35 days, prolonged menstrual bleeding, light periods
Signs or symptoms of high androgens (Testosterone & DHT)
Hirsutism - dark, course hair growth on the upper lip, chest, nipples or lower abdomen
Hair thinning or hair loss
Acne
Possibly pelvic pain as ovarian cysts can cause pain, especially if they rupture
Symptoms/signs of insulin resistance
Fatigue
Increased weight or difficulty losing weight
High blood glucose
Fatigue
Low libido
What are some of the labs that are run if PCOS is suspected?
Well, there are many different labs that may be run depending on your situation. Therefore, this is not a blanket statement, but rather, some of the labs that may possibly be run if suspecting PCOS:
Bioavailable testosterone (this includes total T, free T, SHBG)
Fasting insulin and glucose, hemoglobin A1c
DHEAS
Estradiol, progesterone
LH, FSH
Labs to rule out other conditions: Thyroid panel (TSH, T3, T4, anti-TPO antibodies), prolactin, cortisol, ferritin, hCG (pregnancy test), lipid profile, liver function tests
If I'm diagnosed with PCOS, what are my treatment options?
If you are diagnosed with PCOS, the treatment will depend on what type of PCOS you have and what your labs tell us. My approach is to correct the underlying issue so that may mean enhancing insulin sensitivity, reducing the level of active testosterone or dihydrotestosterone in the body or correcting any imbalances in the sex hormones and optimizing overall function of each body system. Treatment often includes nutrition & lifestyle modifications, herbal medicine, supplements and acupuncture.
Disclaimer: This information is intended for educational purposes only and is not medical advice.