Diagnosing PCOS - Which Type are You?
Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting ~7% of people in reproductive age (USA stats). Development of the disease is often linked to high levels of androgen hormones (e.g. testosterone) from the ovaries, altered luteinizing hormone (LH) action, and insulin resistance. The exact cause remains unclear which is why PCOS continues to be highly misunderstood, and has a mound of misinformation relating to the management of it.
The health complications associated with PCOS can be overwhelming and may include any of the following: infertility, type 2 diabetes, high blood pressure, insulin resistance, elevated cholesterol and triglyceride levels, sleep apnea, non-alcoholic fatty liver disease, and increased risk for mood disorders and eating disorders.
The Endocrine Society Clinical Practice Guidelines recommend using the Rotterdam criteria for diagnosis in adults where 2 of the following 3 criteria are met:
- Androgen excess (showing in clinical or biochemical signs). Clinical signs may include: body hair growth called hirsutism, acne, hair loss on scalp. Biochemical signs include elevated androgens in the blood such as free testrosterone;
- Ovulatory dysfunction such as irregular or absent menstruation. This is defined as cycles greater than 35 days or fewer than 9 periods per year;
- Polycystic ovaries. More than 20 immature follicles in one ovary and/or ovarian volume greater than 10cm3
So, you don’t actually have to have cysts on the ovaries to be diagnosed with PCOS. The Rotterdam criteria further divides PCOS into 4 phenotypes:
- Classic polycystic ovary (chronic anovulation, hyperandrogenism, and polycystic ovaries)
- Classic non-polycystic ovary (chronic anovulation, hyperandrogenism, and normal ovaries)
- Non-classic ovulatory (regular menstrual cycles, hyperandrogenism, and polycystic ovaries)
- Non-classic mild (chronic anovulation, normal androgens, and polycystic ovaries)
Notice that body size and weight are NOT diagnostic indicators. This is important because body diversity exists in the PCOS community, yet weight stigma and size bias exists within this population as demonstrated in recommendations to lose weight to improve PCOS management.
What About Children and Teens?
In children and adolescents, there is potential to over-diagnosis PCOS which can lead to unnecessary treatment and psychological struggle. The 2018 PCOS International Guidelines further state that “ultrasound should not be used for the diagnosis of PCOS in those with a gynaecological age of < 8 years (< 8 years after menarche), due to the high incidence of multi-follicular ovaries in this life stage.” In other words, teens who have had their first period within 8 years should not be given an ultrasound.
The first step to better understanding and managing your PCOS is understanding how it was diagnosed. Majority of my clients with PCOS don’t seem to have all the details about their diagnosis, and often don’t know which questions to ask. I believe it’s important to recognize just how unique PCOS diagnoses and symptoms can be, and how an individual’s experience with PCOS can differ greatly. This ultimately helps to develop a personlized plan to help support the symptoms and health risks associated with PCOS.
If you’re ready to better understand your PCOS and how to best manage it, you can book an appointment online with Brooke HERE or inquire further by emailing her at firstname.lastname@example.org.