Polycystic ovary syndrome (PCOS) was recently revised by the European Society of Human Reproduction and Embryology and by the American Society for Reproductive Medicine because of misdiagnosis among health care providers when using the 2003 criteria.
That criteria stated that a woman who did not ovulate (or rarely ovulated), had symptoms of elevated androgen hormones (such as excess hair growth in unwanted places or acne), and/or ovaries that had multiple cysts on them could be considered PCOS if she had two out of three of those markers.
This brought up an interesting debate as PCOS is often diagnosed in the teenage years, however many teenagers combat acne or have irregular menstrual cycles and are not PCOS. Eventually the cycles might become regular and the acne gets under control.
This led the two main societies to recommend a diagnosis if all three criteria were present, not two out of three. They also focused on the elevated androgen hormones which are testosterone and DHEA, and their effect on unwanted excessive hair growth (upper lip, chin, on the breasts and belly) instead of acne, as acne is not always androgen-stimulated.
Other symptoms common to PCOS are infertility because the woman is not ovulating and having irregular cycles, and excessive weight gain (typically in the abdomen area) due to insulin dysfunction.
When considering PCOS, it’s important to look at a number of lab work markers because of the long-term sequelae. First, if a woman is having menstrual cycles at all, hormone testing commonly done on day 19 or 20 of the cycle (after supposed ovulation) looks at estrogen, progesterone, free and total testosterone and DHEA-sulfate.
If a woman is not cycling, testing of prolactin and thyroid levels are considered. Fasting lab work, including glucose, insulin and cholesterol markers are done.
This is especially important as many believe PCOS starts with insulin’s dysregulation and dysfunction in the body setting off a cascade of endocrine events and greatly increases the risk for cardiovascular disease and metabolic syndrome.