In this article we cover the signs and symptoms of PCOS and the correct way to diagnose PCOS.
Key points:
- PCOS stands for polycystic ovarian syndrome.
- PCOS is an endocrine-metabolic disorder.
- PCOS has nothing to do with cysts on the ovaries (despite its name). “Cysts” are in fact undeveloped follicles on the ovaries, which can be a normal presence in the ovaries.
- PCOS cannot be ruled out or confirmed by ultrasound alone.
- The medical diagnosis of PCOS vs. the FUTURE WOMAN preferred diagnosis.
- Symptoms of PCOS including hirsutism, head hair loss, mood changes, anxiety, irregular periods, infertility, weight gain, missing periods, sugar cravings, acne and more.
What is PCOS?
PCOS stands for polycystic ovarian syndrome, and it is an endocrine-metabolic disorder that affects 4–20% of women worldwide.
PCOS is the most common endocrine (and metabolic) condition in women of reproductive age. It is also the most common cause of anovulatory (lack of ovulation) subfertility in women of reproductive age. Therefore PCOS needs more attention and focus in the medical world, as it affects so many women.
PCOS is not in fact just one disease, but a disorder with different underlying factors. Typically it is defined as androgen excess (when all other causes of androgen excess have been ruled out) and is often accompanied by symptoms such as weight gain, fertility issues, acne, excess body and facial hair growth. Anovulatory androgen excess (AAE) is a more appropriate and accurate name for PCOS. This term was coined by Professor Jerilynn Prior. Anovulatory androgen excess is diagnosed when there are signs of androgen excess as well as irregular cycles.
What are the common SIGNS & symptoms OF PCOS?
The common SIGNS AND symptoms OF PCOS are:
- Head hair loss
- Excess body hair growth (hirsutism)
- Acne (especially around chin and jawline)
- Weight gain (around abdomen)
- Sugar cravings
- Missing periods
- Irregular periods
- Infertility
- Skin tags
- Mood swings
- Anxiety
- Depression
These are the most common signs and symptoms of PCOS, although depending on what type of PCOS you have, signs and symptoms may differ. For example if you have insulin resistance PCOS you may be more likely to suffer from excess hunger and thirst, or if you suffer from adrenal PCOS you may have impacted and interrupted sleep patterns. Read about the 4 types of PCOS to find out which type you might have.
How is PCOS diagnosed?
This is an important fact to note because using ultrasound alone can lead to an over diagnosis of PCOS. You can confirm the presence of polycystic ovaries (the presence of “cysts” or undeveloped follicles) but cannot confirm polycystic ovarian syndrome from ultrasound alone (or for that matter rule it out either).
The medical diagnosis of PCOS is based on having two of the following criteria providing that other causes of your symptoms have been ruled out:
- Signs of raised androgens (male hormones) either clinically (e.g. acne, facial hair or rarely male pattern baldness) or on blood tests (raised testosterone levels)
- Irregular periods or no periods at all
- Polycystic ovaries on an ultrasound scan
At FUTURE WOMAN we prefer a PCOS diagnosis when a woman meets all three of the following:
- Androgen excess with a blood test or symptoms of androgen excess such as hirsutism, acne and weight gain.
- Irregular periods or polycystic ovaries on an ultrasound
- Exclusion of any other conditions that would cause high androgens.
This diagnostic criteria ensures that high androgens are accounted for.
As mentioned PCOS is known as a disorder of androgen excess. This means there are high levels of androgens (including testosterone). In PCOS it is common to have both high free and total testosterone, as well as high DHEA-S. It is also common in PCOS to have high dihydrotestosterone (DHT) which is the more potent androgen caused by high conversion of testosterone to DHT. High androgens are linked to symptoms of excess facial hair, head hair loss, acne, weight gain and fertility issues due to lack of ovulation.
Related article: The four types of PCOS.
References:
Deswal, R., Narwal, V., Dang, A., & Pundir, C. S. (2020). The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. Journal of human reproductive sciences, 13(4), 261–271. https://doi.org/10.4103/jhrs.JHRS_95_18
Garg, A., Patel, B., Abbara, A., & Dhillo, W. S. (2022). Treatments targeting neuroendocrine dysfunction in polycystic ovary syndrome (PCOS). Clinical endocrinology, 10.1111/cen.14704. Advance online publication. https://doi.org/10.1111/cen.14704
Khan, M. J., Ullah, A., & Basit, S. (2019). Genetic Basis of Polycystic Ovary Syndrome (PCOS): Current Perspectives. The application of clinical genetics, 12, 249–260. https://doi.org/10.2147/TACG.S200341
Nautiyal, H., Imam, S. S., Alshehri, S., Ghoneim, M. M., Afzal, M., Alzarea, S. I., Güven, E., Al-Abbasi, F. A., & Kazmi, I. (2022). Polycystic Ovarian Syndrome: A Complex Disease with a Genetics Approach. Biomedicines, 10(3), 540. https://doi.org/10.3390/biomedicines10030540
Rosenfield, R. L., & Ehrmann, D. A. (2016). The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocrine reviews, 37(5), 467–520. https://doi.org/10.1210/er.2015-1104
