I often have clients who have been told in a fleeting comment by GP's that they probably have PCOS (polycystic ovarian syndrome) or perhaps they themselves think something isn't right for them hormonally, and just assume they have the condition (without really understanding what it means). Regardless of how they've concluded that something is up... down there, the real question is... how does PCOS actually get diagnosed and what do they need to do to get actual concrete answers.
Before we look at the how, something to understand is the 'what'. When it comes to PCOS there is the syndrome and then there is polycystic ovaries. While they share similarities - the syndrome is far more complex. Understanding the difference is crucial in how you approach treatment.
Polycystic ovaries VS Polycystic Ovarian Syndrome
Polycystic ovaries refer to ovaries that containing a high density of partially mature follicles. These are identified by a scan.
Polycystic Ovarian Syndrome is a metabolic condition that refers to collection of symptoms which believe it or not may not even involve polycystic ovaries! Crazy right? The condition definitely needs a name change and there are ongoing debates about that (but that's for another day!)
Below is what polycystic ovaries actually looks like:
Image via endocrineweb.com
How is PCOS Diagnosed
In order to be diagnosed with polycystic ovarian syndrome you require two of the following symptoms (according the the widely accepted Rotterdam diagnosis criteria).
1) Polycystic ovaries appearing on internal vaginal ultrasound. This is something ordered by your GP. You'll then be sent for a referral.
2) Oligo / Anovulation (Irregular periods - generally on the longer side 40-60 days apart). This is generally judges by you as the patient. Tracking your cycle each month helps to determine whether you are regular. An average cycle is 28-35 days.
3) Hyperandrogenism (Increased androgens/free testosterone in a routine blood test) AND/ OR Hirsutism (facial growth or associated symptoms such as extra hair growth, acne or male pattern baldness. This is a combination of clinical analysis by your GP and blood tests which your GP will order on your behalf. Good GP's should also test you for metabolic issues with a fasting glucose test. See more on this below.
An additional and very common symptom of PCOS is insulin resistance as a result of elevated androgens. This is why we commonly see PCOS women who are overweight or struggle to maintain a healthy BMI. Testing for this can also be done.
Other common symptoms that should be diagnosed are:
To sum things up, as an example, if a woman has an irregular cycle and symptoms of elevated androgens like male pattern baldness and acne she could have PCOS without her ovaries being polycystic. In these cases, other conditions such as thyroid or pituitary dysfunction need to be excluded before PCOS diagnosis is made. Sadly this is not always the case!
When to get a second opinion
If you've been to your GP, you've told them about your cycle and they've not done any further testing but told you to go on the pill because it will 'balance your hormones'. PLEASE seek help from another practitioner.
If you know that you're underweight and restricting your eating and you've lost your cycle so the doctor tells you to go on the pill. This is not a solution and you likely don't have PCOS. You make actually have Hypothalamic Ammenorhea, which requires and entirely different treatment.
If you don't understand your condition and you don't have two of the symptoms I've listed yet your GP has diagnosed you with PCOS.
If you would like to learn more about PCOS please register for my FREE webinar on Treating PCOS Naturally.