How is PCOS Diagnosed?
How is PCOS diagnosed you might be wondering? PCOS is an underdiagnosed condition - it is a diagnosis of exclusion, and there are various barriers to diagnosing it. If you're thinking you might have PCOS, your doctor will want to test your blood to understand if there are other conditions that could be causing what you think are PCOS symptoms. These other conditions might include hypothyroidism, which tends to mimic many of the symptoms of PCOS. Thyroid conditions can cause menstrual irregularities, cystic ovaries, hair thinning, weight challenges, and various other symptoms that look like PCOS. This is just one example of another condition your doctor may want to rule out before diagnosing PCOS.
The Rotterdam Criteria
However, once other conditions are ruled out, PCOS is currently diagnosed in accordance with the Rotterdam criteria, where the patient must have at least two of the following indicators present to receive a clinical diagnosis:
1. Oligo-Ovulation or Anovulation
Oligo-ovulation indicates the presence of irregular or infrequent periods. The recognized "regular" cycle generally lasts about 21 to 35 days. Oligo-ovulation indicates the cycle is longer than 35 days, meaning you may only get a period 8 times per year or fewer. Anovulation indicates the absence of periods altogether. Some PCOS patients may also experience extremely long periods when they do come.
2. Hyperandrogenism (Observed or Biological)
Everyone has androgens, males and females alike. However, if androgens are elevated in the female body, it may cause hirsutism, which is facial or body hair growth, alopecia or hair thinning on the head, acne, or a variety of other physical manifestations. So, your doctor may use observational techniques to conclude there are excess androgens, or your doctor may want to take a blood test to see if there are elevated testosterone levels.
3. Cystic ovaries visible on ultrasound
The good old namesake of PCOS. And ironically, these are not actually cysts. Nor does everyone who has PCOS have "cysts" on their ovaries. And, if you have cysts on your ovaries, it doesn't necessarily mean PCOS. Your doctor will perform a transvaginal ultrasound to see if they can observe these follicles on your ovaries. And, by the way, that's what these actually are. These "cysts" are fluid-filled sacks that started as follicles on our ovaries. The follicle's purpose is to hold eggs to later be released and fertilized. However, because of imbalanced hormones, the eggs may not fully mature, and the follicles fill with fluid, thus leading to the presence of a "cyst" on the ovary.
While there is debate around whether these should in fact be the criteria used to diagnose PCOS, it is what is used in a clinical setting today.
Barriers to Diagnosis
Now, to add to the complexity of the diagnosis process, there are barriers to diagnosis. One of the most common treatments for PCOS is hormonal birth control that works to manage the hyperandrogenism present in many PCOS patients. However, because the hormones effectively limit the amount of testosterone circulating in the body and limit the effects of androgens, that means we often cannot observe one of these criteria when an individual is using hormonal birth control. Additionally, the hormonal birth control often produces a menstrual cycle on a regular basis. And in many cases, the hormonal birth control prevents the formation of “cysts” on the ovaries. So, it’s incredibly difficult to detect the criteria that are used to diagnose the endocrine disorder.
This is part of the reason why many individuals live undiagnosed - they begin using hormonal birth control often in their teens, whether to control acne, prevent pregnancy, or for some other reason, and often stay with it until they want to try to conceive. It is often not until there are issues with fertility that PCOS is detected, which can shed light on why a person has dealt with many symptoms, like stubborn weight, fatigue, anxiety, and more, for such a large portion of their life.
Getting a diagnosis
The best thing to do is to screen during adolescence when symptoms may begin to present. Additionally, if you know that a close blood relative has PCOS, such as a sister or mother, it may be an indication of something you want to keep an eye out for yourself, or, in the future, for your daughter.