Polycystic Ovarian Syndrome (PCOS), Pt 1: Diagnosis
Polycystic ovarian syndrome (PCOS) is one of the common conditions that people come to see me for in-office. They often complain of cystic acne in addition of irregular cycles and want to get to the root cause of their symptoms and treat their symptoms with naturopathic options. PCOS is seen in 15-20% of females and can experience cystic acne, facial/body hair growth, head hair thinning, difficulty conceiving/infertility, and/or irregular or absent menstrual cycles, and often have comorbidities of metabolic syndrome, high blood pressure, cholesterol issues, blood sugar issues/diabetes, and more. It should be noted that PCOS is considered a life-long condition, and there have yet to be studies that reveal that is it curable. So, many natural/integrative/pharmaceutical interventions will manage symptoms and reduce the severity of symptoms.
This is the first part of a 3-part series that dives into PCOS. In this first part, you will learn about diagnosis and the different types of PCOS. In subsequent parts, you will learn about workup and testing and naturopathic treatment options for PCOS.
Diagnosis
Diagnosis for PCOS is completed via the Rotterdam 2003 Criteria. According to the Rotterdam 2003 Criteria, to be diagnosed with polycystic ovarian syndrome, patients must have at least 2 of the following signs & symptoms:
Menstrual cycles: Cycles that are 35+ days long OR less than 9 menstrual cycles per year
Symptoms of high androgens (cystic acne, facial hair, scalp hair thinning) or labs showing high androgens
Ultrasound showing polycystic ovaries with 12+ ovarian follicles
A common PCOS question That I get is: “What is the difference between PCO and PCOS?” And, the answer is: PCO stands for “polycystic ovaries” and usually appears on ultrasound.PCO usually indicates that the person does not have any of the other symptoms needed for the diagnosis of the syndrome, and only experiences polycystic ovaries.
Another common PCOS question that I get is: “Is ultrasound is necessary for the diagnosis of PCOS?” And, the answer is: no.
By following the Rotterdam 2003 Criteria, doctors will be able to diagnose PCOS as long as all other conditions are ruled out. PCOS diagnosis is a diagnosis of exclusion, which means that other conditions that looks like PCOS should be ruled out before PCOS is diagnosed.
The conditions that look like PCOS are:
Hypothyroidism
Hyperprolactinemia
Non-classic congenital adrenal hyperplasia
Cushing’s syndrome
Hypogonadotopric hypogonadism
Androgen-secreting tumors
Different types of PCOS
By using the Rotterdam 2003 Criteria, this allows for different subtypes of PCOS. These subtypes are:
A: Frank or “Full Blown” PCOS = Presence of all symptoms and/or signs of PCOS
B: Non-polycystic ovaries PCOS = Presence of menstrual symptoms + symptoms and/or labs showing high androgens, but no ultrasound showing polycystic ovaries
C: Ovulatory PCOS = Presence of symptoms and/or labs showing high androgens + ultrasound showing polycystic ovaries, but no menstrual symptoms
D: Non-hyperandrogenic PCOS = Presence of menstrual symptoms + ultrasound showing polycystic ovaries, but no symptoms or labs showing high androgens
Summary
If you have a suspicion that you have PCOS, make sure to speak to your trusted provider about your testing options so that you can see if what you are experiencing is PCOS or another condition. Having a licensed naturopathic doctor in your health and wellness team will also offer in-depth insight to identifying and better-treating root causes of your symptoms. Additionally, if you have any friends, family, or loved ones who might be experiencing any of the symptoms or common concerns above, make sure to share this post with them and let them know to follow along for this series on PCOS!
Also make sure to sign up for my email list to get email notifications when future blog posts are published on my website!