POLYCYSTIC OVARIAN SYNDROME (PCOS)

5. How is polycystic ovarian disease diagnosed?

What is Polycystic ovarian Disease?
What causes PCOS?
What are some symptoms of PCOS?
What are the hormone changes in PCOS and their implications to the woman’s health?
How is PCOS diagnosed? What tests are done?
When should I become alert about myself or someone I care for, about PCOS?
How is PCOS treated?
Will PCOS affect pregnancy?
Does PCOS put women at risk for other health problems?
What can I do to prevent complications?
Emotional aspects of PCOS

How is PCOS diagnosed? What test are done?
What information should I gather to give the doctor?

No single test can diagnize PCOS. Your doctor will take your medical and family history, conducts physical examination and a series of tests to find out if you have PCOS or if something else is causing your symptoms.

Medical history. Your doctor will ask about your menstrual history, weight changes, and other symptoms. Will enquire if your close blood relatives have a history of Hirsutism , Adrenal enzyme deficiencies, Menstrual disorders, PCOS, Diabetes and Infertility.

Physical exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.

Pelvic exam. Your pelvis is examined to see if the ovaries are enlarged .

Blood tests. Ordered to check levels of various hormones in the blood. Each hormone or set of hormones helps the doctor to understand the state of PCOS and differentiate it from other mimicking health conditions.

The commonly performed biochemical tests include assay (estimation) of the hormones FSH, LH, Prolactin, Thyroid hormones, 17-hydroxy progesterone Free Testosterone and DHEAS. In patients with PCOS, FSH levels are within the reference range or low. LH levels are elevated. The LH-to-FSH ratio is usually more than 3.

Samples for laboratory studies are drawn early in the morning, with the patient in a fasting state, and, in women with regular menses, between days 5 and 9 of the menstrual cycle. For those who have irregular periods, tests are first conducted to rule out pregnancy.
A glucose tolerance test is usually done because of the high prevalence of type 2 diabetes mellitus in women with PCOS. Following a 75 g oral glucose administration, blood glucose is tested after 2 hrs. value of 140-199 mg/dL indicates impaired glucose tolerance, and a value of 200 mg/dL or higher indicates diabetes mellitus. Approximately one third of women with PCOS who are overweight have impaired glucose tolerance or type 2 diabetes mellitus by age 30 years.

Some women with PCOS have insulin resistance and an abnormal lipid profile (cholesterol >200 mg/dL; LDL >160 mg/dL). Therefore, a Lipid profile is also taken.

Additional test may be necessary to rule out illnesses that also cause polycystic ovaries - for example, checking a 24-hour urine sample for free cortisol and creatinine to rule out Cushing syndrome.

A number of conditions that mimic polycystic ovarian syndrome (PCOS) should be ruled out before the diagnosis of PCOS is confirmed. They include

• Ovarian hyperthecosis
• Late-onset Congenital adrenal hyperplasia
• Drugs (eg, danazol, androgenic progestins)
• Hypothyroidism
• Obesity
• Patients with menstrual disturbances and signs of hyperandrogenism
• Hirsutism due to unidentified causes
• Hirsutism that runs in families
• Tumors of the adrenal gland or ovary that produce masculine characteristics
• Cushing syndrome
• Excessive prolactin hormone
• Use of steroids etc.

Vaginal ultrasound (sonogram). Next the doctor may perform ultrasound scan to examine your ovaries for cysts and check the endometrium lining of the womb (endometrium). This lining may become thicker if the periods are not regular.

 Next: 6. When should I become alert about myself or someone I care for, about PCOS?

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