Polycystic Ovarian Syndrome Symptoms and Diagnosis

There is no simple test for Polycystic Ovarian Syndrome (PCOS). Your health care professional will do a thorough history and physical examination, perhaps with lab tests, to determine whether your symptoms stem from PCOS or another disorder. Diagnosis begins with an inventory of symptoms, the most common of which are:

  • Hirsutism (excess body and/or facial hair, particularly on the chin, upper lip, breasts, inner thighs and abdomen)
  • Irregular or infrequent periods
  • Obesity
  • Acne and/or oily skin (particularly severe acne in teenagers or acne that persists into adulthood)
  • Infertility
  • Ovarian cysts
  • Hair loss or balding
  • Acanthosis nigricans (darkening of the skin, usually on the neck; AN is a sign of insulin problems as well)
  • Skin tags, small pieces of excess skin in the armpit or neck area

Women with PCOS may have varying combinations of symptoms, but two essential features of the disorder are:

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  • Hyperandrogenism, excess blood levels of androgens or symptoms indicating hyperandrogenism. Androgens are hormones such as testosterone that, in excess quantities, cause such symptoms as hirsutism and acne. In more severe cases, "virilization" may take place, including such symptoms as clitoromegaly (an enlarged clitoris), balding at the temples, voice deepening and muscle growth.
  • Lack of ovulation, or irregular ovulation along with irregular or absent menstruation. Women with PCOS may have oligomenorrhea (eight or fewer periods per year) or amenorrhea (absence of periods for extended periods). Some women with PCOS have polymenorrhea, or periods that are too frequent.

Polycystic Ovarian Syndrome Symptoms and Diagnosis (<i>cont'd</i>)

Hormonal disorders are complex, and symptoms often suggest more than one potential cause. The diagnostic process likely will include a thorough physical and history to check for hypothyroidism, Cushing's syndrome and tumors. While there is no test for PCOS, a health care professional may want to measure your blood levels of the following:

  • Thyroid hormone (symptoms of low thyroid function are often similar to those of PCOS)
  • Prolactin (high levels of this hormone, which stimulates milk production, often results in irregular or absent menses similar to those of PCOS)
  • Androgens, including dehydroepiandrosterone sulfate and testosterone (high levels of these hormones, often referred to as “male hormones,” are frequently associated with PCOS and cause “male-like” symptoms such as excess body or facial hair)
  • Level of follicle-stimulating hormone and luteinizing hormone (a high ratio of LH to FSH — typically three-to-one — is characteristic of PCOS; follicle stimulating hormone promotes the development of egg-containing follicles in the ovaries, while luteinizing hormone stimulates ovulation, follicle rupture, and encourages the empty follicle to convert to progesterone production.)

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Polycystic Ovarian Syndrome Symptoms and Diagnosis (<i>cont'd</i>)

These tests should be interpreted by a health care professional familiar with them, such as an endocrinologist or reproductive endocrinologist. The best time to be tested is in the morning shortly after the beginning of a menstrual period (you may need medication to induce menstruation). You should know that birth control pills, because they change hormonal balance, might make the tests worthless.

Your health care professional may also order ultrasound imaging of the ovaries to look for the characteristic picture of multiple cysts. The test involves insertion of a probe into the vagina. Such a test, however, is not definitive, since it is very common for women without PCOS to have cysts; it is also common for women with PCOS not to have cysts. The ultrasound, however, can help confirm a diagnosis and is the single most reliable way of making a diagnosis as long as it is done by a physician who understands variations in the ovarian image. It also allows simultaneous examinations of the endometrial lining for abnormalities. Health care professionals rarely remove benign cysts, opting more often to prescribe lifestyle modifications and medication to treat symptoms.

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If you have PCOS, you should be tested and treated for other conditions that are associated with the syndrome (or thought to be), such as insulin resistance and type II diabetes, obesity, high blood pressure and elevated blood lipids (cholesterol and triglycerides). The connection between PCOS and insulin and lipid problems is a strong one, though the reasons are not thoroughly understood.

About one in 10 cases of diabetes in premenopausal women can be linked to PCOS. The syndrome may also boost risk for heart disease, although long-term, definitive studies have yet to be completed.

Some drugs are associated with “masculinization” symptoms, most notably steroids. Alternative medications may take care of the problem.

Occasionally, such symptoms are the result of an androgen-producing tumor. If your testosterone level is above 200 mg/dl, your health care professional may want to investigate further.

Copyright 2003

National Women's Health Resource Center Inc. (NWHRC).