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Why Does My Doctor Think I Have Polycystic Ovarian Syndrome (PCOS)?

By Cary L. Dicken, MD

Polycystic Ovarian Syndrome (PCOS) is a diagnosis commonly given with women with irregular periods.  The truth about PCOS is that not all women with this diagnosis have the stereotypical characteristics.  If you do an internet search for PCOS you are likely to find images or descriptions of overweight women with acne and excessive/male pattern hair growth.  In reality, women with PCOS tend to fall somewhere along the spectrum of symptoms.  Bottom line, not all women with a PCOS diagnosis are the same.

PCOS is a diagnosis of exclusion.  What does that mean?  Your doctor needs to rule out all other reasons why your periods may be irregular before suspecting PCOS.  In addition, a diagnosis of PCOS requires that women have two of the following findings:

  1. Irregular periods.
  2. Evidence of elevated androgens – either physically (i.e. male pattern hair growth) or based on laboratory results.
  3. Polycystic-appearing ovaries on ultrasound.

Technically, if a woman meets two of the above criteria, and there is no other explanation for why her periods are irregular, she is PCOS.  Women with PCOS, despite not “appearing” like the stereotypical woman with PCOS, should be treated no differently.  Testing for associated conditions like impaired glycemic control and high cholesterol is important.  Irregular hormone levels and metabolic conditions can affect egg quality, which of course then impacts fertility, miscarriage and pregnancy complications.

Management of PCOS depends on a woman’s reproductive goals.  When a woman with PCOS is not interested in getting pregnant, the treatment for PCOS may be as simple as taking a birth control pill.  When pregnancy is desired, then fertility treatment may be required.  The irregular periods associated with PCOS are due to delayed and irregular ovulation.  Any woman with PCOS will tell you that it is difficult to time intercourse in hopes of conceiving because she never knows when she is going to ovulate.  Apps and home ovulation kits are often unreliable for women with PCOS.  Achieving pregnancy may be as simple as using an oral medication like Clomiphene Citrate to induce ovulation.  Some women with PCOS however do not respond to oral medication alone and may require more advanced treatment like intrauterine insemination (IUI) or in vitro fertilization (IVF) to achieve a healthy pregnancy.  The choice of treatment is not only dependent on a woman’s diagnosis of PCOS, but also takes into account her age, additional history, family plan and her partner’s fertility testing.

Other than fertility treatment, women with PCOS should make lifestyle choices and consider supplements aimed at improving egg quality.  Your doctor can recommend over the counter options and depending on test results may also discuss prescription medication as well.  Lifestyle changes geared toward weight loss and a low-carb diet can also be beneficial for women with PCOS.