An accurate diagnosis

The name "polycystic ovary syndrome" has been described as misnomer as when we are talking about PCOS the word 'cyst' is actually referring to antral follicles (ovarian follicles).

The name is not the only confusing thing about PCOS, the diagnostic criteria can also cause confusion! Did you know that there are three criteria that have been proposed for diagnosing PCOS, although all three criteria agree that PCOS is a diagnosis of exclusion, they don't all agree on what should and should not be a PCOS diagnosis.

National Institutes of Health criteria (NIH), defined in 1990

Both required:

• Irregular ovulation

• Clinical/biochemical signs of hyperandrogenism

Rotterdam Criteria, defined in 2003

2 out of 3 required:

• Irregular ovulation

• Clinical/biochemical signs of hyperandrogenism

• Polycystic ovaries

The Androgen Excess and PCOS Criteria (AE-PCOS Society), defined in 2006

Both required:

• Ovarian dysfunction and/or polycystic ovaries

• Clinical/biochemical signs of hyperandrogenism

As all three criteria agree that PCOS is a diagnosis of exclusion, this means under any criteria, PCOS cannot be diagnosed or ruled out by ultrasound alone.

So how do you get an accurate diagnosis?

If you are experiencing irregular ovulation/periods, and physical signs of excess androgens such as excess body hair, acne or male pattern hair loss, you will need to be tested for PCOS and any conditions that mimic PCOS. It's important to ask your practitioner to test for adrenal androgens and not just testosterone, DHEA is an adrenal androgen and can be high in some, with PCOS.

Some conditions that can mimic PCOS are:

• Hypothalamic Amenorrhea (although androgens tend to be low or normal in HA)

• Hypothyroidism (request a full thyroid, including, TSH, Antibodies, T3 & T4)

• Cushing's syndrome

• Hyperprolactinemia

• Non-classic congenital adrenal hyperplasia (NC-CAH)

Once you are sure all conditions that can mimic PCOS have been ruled out and you have an accurate PCOS diagnosis, you can then begin investigating what is worsening or contributing to your PCOS.

Let's take a look:

Insulin resistance - affects up to 80% of women with PCOS. Insulin is a hormone the pancreas produces to help the body use sugar from foods for energy. When cells cannot use insulin properly, the body’s demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin causes the ovaries to produce more androgens. Obesity is a major cause of insulin resistance. Obesity increases some features of PCOS such as hyperandrogenism, hirsutism and pregnancy complications and both obesity and insulin resistance increase diabetes mellitus type 2 and cardiovascular diseases.

Inflammation - Chronic low-grade inflammation is a key contributor to Polycystic Ovary Syndrome (PCOS). Markers of oxidative stress and inflammation are linked with circulating androgens. A study revealed that CRP is the most reliable circulating marker of chronic low-grade inflammation in PCOS. It's important to remember that inflammatory triggers differ from person to person, so it's important to look out for what causes you inflammation.

Stress - plays a part in the cause and worsening of PCOS. Studies have shown a heightened stress response in those with PCOS and that cortisol is dysregulated in PCOS, mainly through increased hypothalamic-pituitary-adrenal (HPA) axis activity and enhanced cortisol secretion.

These are just some of the factors that contribute to PCOS, and your treatment approach will depend on what your results reveal and route you want to take.

Ailish 🌻