Is it PCOS or HA?

Polycystic Ovary Syndrome (PCOS) and Hypothalamic Amenorrhea can present very similar but they are very different and require a different approach.

PCOS is an endocrine/metabolic syndrome characterised by androgen excess, irregular/absent periods and polycystic ovarian morphology. Although PCOS has been recognised for many years the diagnosis still causes debate. However, both high

androgens and insulin resistance are some of the most common features seen in PCOS.

Hypothalamic Amenorrhea is due to suppression of gonadotropin releasing hormone (GnRH) in the brain resulting in low follicle stimulating hormone (FSH) and luteinizing hormone (LH). It's basically your brains decision to shut down ovulation, as a result of undereating, over exercising or stress. Absent periods and polycystic ovarian morphology can be seen in HA.

The key differences between PCOS and HA are:

1). Luteinizing Hormone (LH): In PCOS it is regularly continuously elevated and in HA it is low.

2). Cervical fluid: In PCOS it is abundant, in HA is it scant.

3). Bone loss: In PCOS, not a huge risk, in HA, bone loss is a risk.

4). Androgens: In PCOS they are elevated, where as they appear to be normal or low in HA.

5) .Fasting insulin: Normal or high in PCOS, but lower in HA.

So the question is, why are women commonly misdiagnosed?

Well, the problem is, all of these years on and still there is no consensus on the PCOS diagnostic criteria. National Institute of Health (NIH), Rotterdam and Androgen excess and PCOS society (AE-PCOS) criteria, all agree that PCOS is a diagnosis of exclusion, but the Rotterdam Criteria allows for a diagnosis of PCOS when androgens are not elevated. So, if you are diagnosed based on an ultrasound and the fact that you have irregular periods, this does not rule out any other conditions, and can in fact be as a result of many other conditions, one being HA.

So how do you get an accurate diagnosis?

Get all of necessary bloods:

SHBG

DHEAS

Cortisol

Estrogen

Prolactin

Vitamin D

Testosterone

Androstenedione

FSH/LH (day 2/3)

Fasting Insulin/Glucose

Full thyroid panel (including FT3)

Progesterone - 7 days after ovulation

17-OH Progesterone

Pelvic ultrasound (optional)

Take charge of your health!

Áilish 🌻