PCOS Diagnosis Criteria and PCOS Treatment

By Anjanette Tan, MD, FACE, ECNU and Yasasvhinie Santharam, BSMedically reviewed by Anjanette Tan, MD, FACE, ECNU, Dr. Tan is a Board Certified Endocrinologist who is an expert on hormones in PCOS, PCOS diagnosis, PCOS insulin resistance, and PCOS treatment.
7 min read

Polycystic Ovary Syndrome, abbreviated as PCOS, is a hormonal condition characterized by any two of the following: 

·   Irregular menstrual periods

·   Having signs or lab values of excessive androgens (“male hormones”)

·   Polycystic ovaries on ultrasound

It is the most common hormonal disorder in females of reproductive age (1). Females are at higher risk for PCOS if they have family members with PCOS or are obese (2).

 

PCOS Syndrome (3)

The following PCOS symptoms are a generalized group that have been noted in individuals with PCOS in the past, but they overlap with many other diseases. If you have any combination of these symptoms, it does not always mean you have PCOS. Rather, they are an indicator that it might be good to check if you do.

See: PCOS Symptoms for more

 

PCOS Insulin Resistance And Endocrine/Metabolic Issues

·   Insulin Resistance

·   Diabetes

·   Weight gain

PCOS Fertility Issues And Problems With The Reproductive System

·   Patients can have enlarged ovaries that have multiple cysts or follicles surrounding them. This can be seen on ultrasound

·   Irregular menstrual cycles (less than 9 periods/year or intervals over 35 days)

·   Pelvic pain

·   Fertility issues

 

PCOS Acne, Skin, and Hair Issues

·   Hirsutism (excessive hair growth)

·   Alopecia

·   Acne

·   Acanthosis nigricans (patches of thick, darkened, velvety skin in armpits, neck, and groin)

·   Skin tags

 

PCOS Depression

·   Patients can have mental health struggles - specifically depression.

 

Hormones In PCOS

There are many potential genes and environmental factors that can work together to cause PCOS. Doctors aren’t sure what exactly causes PCOS itself, but some of the factors that cause the endocrine changes of PCOS are:

 

High Androgens In PCOS

Androgens are sometimes called “male hormones” because male bodies generally make more than female bodies do. In females with PCOS, the hormones are out of balance since they have higher than normal levels of androgens, which can interfere with ovulation, cause ovarian cysts to mature, and cause symptoms like excess hair growth or acne (2).

 

PCOS Insulin Resistance And Risk Of Diabetes

Insulin is the hormone produced by the pancreas which helps move sugar (aka glucose) from the blood into the cells to use as energy. If cells are “insulin resistant”, it means they might need 2, 3, or 4 molecules of insulin to open up each cell instead of just the normal one, and glucose stays in the blood at first. The body then starts to think it didn’t make enough insulin, so it produces more insulin to drive the glucose into the cells.

 

This increase in insulin levels increases the production of androgens. For younger females with PCOS, their pancreas can usually keep up with the increased need for insulin production, but this can cause problems (including diabetes) later in life when the pancreas slows down. High insulin levels are also linked to a skin condition called Acanthosis nigricans (2). 

Related: PCOS Symptoms

Your endocrinologist can monitor your insulin and androgen levels through blood exams, and work with you to come up with a treatment plan as needed. Insulin resistance is the key focus of endocrinologists when it comes to PCOS, since it can affect so many other factors in the body, as described above.

 

PCOS High Cholesterol (Hyperlipidemia)

Folks with PCOS who have insulin resistance can also have low levels of HDL (high density lipoprotein, aka the “good cholesterol”) and high levels of VLDL (very low density lipoprotein, aka “bad cholesterol”) and triglycerides (4). Your doctor will monitor cholesterol levels to check the status and see if any medication is needed to treat it.

Weight Gain In PCOS

PCOS is closely linked with obesity, based on multiple epidemiological and genetic studies. In fact, a significant proportion of folks with PCOS (anywhere from 38-88%) are either overweight or obese (6). Insulin resistance and elevated insulin levels (hyperinsulinemia) are contributing factors to weight gain in PCOS. Your doctor can help with the weight gain through making diet and exercise recommendations that work best for you.

PCOS Heart Disease

Folks with PCOS have been shown to have higher rates of coronary artery disease (CAD). This is associated with the increased cholesterol levels, increased insulin resistance, weight gain around the abdomen, and hirsutism (6). Your endocrinologist may work with a cardiologist and your primary care physician to work on a diagnosis if they suspect cardiovascular disease.

 

 

How Do You Know If You Have PCOS?

Since the symptoms of PCOS can potentially overlap with other endocrine and non-endocrine causes, the best way to know if you have PCOS is to visit your primary care physician or an endocrinologist. By reviewing your blood work, insulin levels, and listening to your history, they can accurately diagnose and recommend a plan of care or follow-up.

Check out How to know if you have PCOS for more

 

Is PCOS Curable?

PCOS is not curable but it can be treated. PCOS is treated differently in each individual, depending on the cause and severity. Your primary care physician or endocrinologist will obtain your medical history, blood tests and possibly ovary ultrasound imaging to recommend a plan of care.

 

Treating PCOS involves (1):

 

Lifestyle Modification

In overweight or obese folks with PCOS, exercise and calorie-restrictive diets are a first line treatment to help with weight loss and insulin resistance.

 

Hormonal Contraceptives

Your healthcare provider may recommend a hormonal contraceptive since they have been shown to help keep the acne, irregular menstrual periods, and hirsutism under control. According to the Endocrine Society, there’s no particular form of hormonal contraceptive that’s best overall. So, you will work with your provider to figure out which form of hormonal contraceptives are best for your body.

 

PCOS Metformin Treatment 

Metformin is given to PCOS patients who may have Type II Diabetes or insulin resistance that doesn’t adjust with lifestyle modifications. It also helps with improving menstrual cycles.

 

PCOS Treatment For Infertility 

Infertility treatments can be given to patients whose PCOS has impacted their fertility, if they wish to have children. Patients can work with their primary care physicians, endocrinologists, and also REIs (reproductive endocrinology and infertility physicians) to determine the best course of treatment.

PCOS is a challenging condition that affects many persons. It requires involvement from multiple doctors including your Ob Gyn, an endocrinologist, a dermatologist, and possibly a mental health professional.

Sources:

 

  1. Rasquin Leon LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2021 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/
  2. https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes
  3. Ndefo, U. A., Eaton, A., & Green, M. R. (2013). Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P & T : a peer-reviewed journal for formulary management, 38(6), 336–355.
  4. Kim, J. J., & Choi, Y. M. (2013). Dyslipidemia in women with polycystic ovary syndrome. Obstetrics & gynecology science, 56(3), 137–142. https://doi.org/10.5468/ogs.2013.56.3.137
  5. Barber, T. M., Hanson, P., Weickert, M. O., & Franks, S. (2019). Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. Clinical medicine insights. Reproductive health, 13, 1179558119874042. https://doi.org/10.1177/1179558119874042
  6. Robert A. Wild, Enrico Carmina, Evanthia Diamanti-Kandarakis, Anuja Dokras, Hector F. Escobar-Morreale, Walter Futterweit, Rogerio Lobo, Robert J. Norman, Evelyn Talbott, Daniel A. Dumesic, Assessment of Cardiovascular Risk and Prevention of Cardiovascular Disease in Women with the Polycystic Ovary Syndrome: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society, The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 5, 1 May 2010, Pages 2038–2049, https://doi.org/10.1210/jc.2009-2724

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