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Polycystic ovarian syndrome (PCOS) affects millions of women in the United States. It causes a variety of fertility, hormone, skin and ovarian problems.
In January 2013, a panel based on the Evidence-based Methodology Workshop at the National Institutes of Health, suggested renaming and redefining the diagnostic criteria.
They reported that PCOS should be determined by meeting two out of three criteria:
- excess androgens
- ovulatory issues
- multiple cysts in the ovaries
This eliminates the requirement for ovarian cysts in the absolute diagnosis as many people currently believe.
Typical symptoms of PCOS include:
- excessive hair growth in places women typically do not want it
- missed periods or irregular periods
- not ovulating
- weight gain especially around the middle
- blood sugar and insulin problems
- fertility problems
- ovarian cysts
Androgens are a group of hormones such as DHEA, testosterone, androstenedione, and dihydrotestosterone that cause the skin and hair complaints.
Testing for PCOS can be difficult and as it is very multi-factorial.
First, evaluating for symptoms is important. Next, testing must be done for androgens and looking for elevated levels. Evaluating the menstrual cycle history is needed to see if it is regular (roughly every 26 to 32 days) and if she ovulates.
Testing for fasting blood sugar and insulin levels may indicate further consequences. An ultrasound will visualize cysts on the ovary and discussing fertility challenges are important.
One of the issues the panel discussed was the difficulty in diagnosis, as women will see different doctors or specialists for different issues.
A woman having trouble conceiving may see a fertility specialist while the woman with no menstrual cycle visits her gynecologist. Acne and hair growth around the upper lip, chin, neck, nipples and abdomen may be evaluated by a dermatologist or aesthetician.
If all symptoms are not accounted for, PCOS may be missed. Also, women and their doctors may rule PCOS out if the ultrasound does not show multiple cysts on the ovaries, even if she has all the other symptoms.