Polycystic ovary syndrome (PCOS) is an endocrine disorder that can be hard to identify. Nurse Practitioner Monica Moore explains the diagnostic process.
July 12th, 2024 | 5 min. read
Ask Monica is a Q&A video series hosted by Nurse Practitioner Monica Moore.
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Think you might have PCOS?
Although you may be familiar with polycystic ovary syndrome (PCOS), a common endocrine condition that can cause the growth of ovarian cysts, hormonal imbalances, fertility issues, and a range of other physical symptoms, you still might be wondering how this condition is diagnosed. In this episode, we break down the process of diagnosing PCOS.
Monica Moore:
Hi, everyone. I'm Monica Moore, nurse practitioner at Illume Fertility, here today to talk to you about one of my favorite topics, which is PCOS, or polycystic ovary syndrome. Going to be using the whiteboard, which is why we have it here.
A question I get asked frequently is, "Do I have PCOS? And how is it diagnosed?"
I think most people who have PCOS have a thought that something is going on. I just want to emphasize that PCOS is a syndrome, but otherwise known as kind of a chronic condition that is not treated and it's managed. We do talk about that in other videos.
Understanding the Rotterdam Criteria
The criteria that we use in the diagnostic process is called the Rotterdam criteria. In order to formally get diagnosed with PCOS, you have to have two out of these three signs. Let's review each one together:
PCOS Sign #1: Irregular Menstrual Cycles
In terms of how do you know you have PCOS, the most common sign is irregular menstrual cycles. You never know when your period is coming. When your period does come, it can often be heavy, unpredictable, and disruptive to your life.
This doesn't refer to somebody who gets a period every 35 days (instead of a typical 28-day cycle), but instead once every three to four months. So, the first sign of PCOS is irregular menstrual cycles.
PCOS Sign #2: PCOS-Appearing Ovaries
The second sign is PCOS-appearing ovaries. This means they are very active ovaries. In someone who doesn't have PCOS, the ovary may have a couple follicles. PCOS-appearing ovaries are often much larger.
Note: A normal ovary is 2-3cm. PCOS-appearing ovaries could be 3-5cm. And there are many, many, many follicles (which are fluid-filled cysts that hold the egg) that are situated around the periphery of that ovary.
And why do we have these? Because none of the follicles have the particular hormonal environment or cascade necessary for one of the follicles to become mature. In contrast, you can see this one over here [in a typical ovary] is becoming mature, and will ovulate.
With PCOS, your follicles stay in that resting state, not mature enough to ovulate, and remain in the ovary. And that's where the "cyst" part comes from - they're actually follicles, not cysts.
If you're a teenager or a young woman, your ovaries might look like this [filled with many follicles] anyway. So you don't always have to meet that PCOS-appearing criteria to be diagnosed.
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PCOS Sign #3: Androgen Excess
The third criteria are signs of what's called androgen excess.
Androgens are "male" hormones. Even women have certain amounts of male hormones. We need to in order to make other hormones. But when you have PCOS, you can have either clinical evidence of androgen access, which means we draw a blood test and we see higher levels of these hormones, such as free testosterone.
Or you may have clinical (I guess I should say clinical is when you show a sign of it) signs of androgen excess - like excessive hair growth or male-pattern hair growth, which for many people could be along what we call "sideburns," or on your chest, around the belly button, top of the thighs, or anywhere else. But that hair growth is typically heavier, coarser, and darker.
And if you are an ethnicity that does not have clearly dark body hair, maybe Scandinavian, we would run some blood work on you, which we do anyway. And if we see those signs of, let's say, elevated androgen in your test results, you would be diagnosed using this criteria.
Why is PCOS frequently misdiagnosed?
Often, people with PCOS are misdiagnosed or late to get diagnosed because they see multiple providers. So they'll see maybe a dermatologist for acne or hair growth.
They'll see a pediatrician (depending on how old they are) or a gynecologist for irregular cycles. And not many people are having ultrasounds unless they need to. So we're missing that sign of PCOS-appearing ovaries.
Should you be diagnosed with this condition, you need to go see a provider that has a comprehensive PCOS group or specialized clinic, so that we can manage your symptoms all together and not give you what we call "fragmented care" - going to a different doctor for each symptom.
Hope that's helpful! See you next time, and please feel free to email us, go to our website, or write in the comments what you want to hear from us next time.
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Do I have PCOS?
Irregular cycles? Trouble conceiving? Take this short assessment to see if you might have PCOS.
