Diagnosis of Polycystic Ovary Syndrome

Diagnosis of Polycystic Ovary Syndrome

Women are diagnosed with PCOS if they have any combination of irregular periods, excess androgen and polycystic ovaries.

This means there are 4 types of PCOS:

• Type A (irregular periods, excess androgen, polycystic ovaries)
• Type B (irregular periods, excess androgen, normal ovaries)
• Type C (regular periods, excess androgen, polycystic ovaries)
• Type D (irregular periods, normal androgen, polycystic ovaries)

However, correct diagnosis of PCOS is a multi-step process to rule out other possible causes (e.g. adrenal disorder, hyperthyroidism, hyperprolactinoma, androgen secreting tumours in rare cases). This process involves:

• Physical examination
• Blood tests
• Ultrasound scan

At the initial consultation the doctor will firstly ask you about your symptoms and menstrual history before carrying out a physical examination to check for clinical signs of hyperandrogenism (e.g. excess acne, facial or body hair and male pattern baldness). By the end of the consultation, the doctor may make a preliminary diagnosis of PCOS, which should be confirmed with blood tests regardless of age.

Blood tests are essential to confirm your symptoms and signs is caused by PCOS and not another condition. These blood tests should include:

• Total Testosterone, free Testosterone, DHT, A4, SHBG, LH, FSH and AMH to confirm PCOS.
• Cortisol (or 17α-hydroxyprogesterone), DHEA, DHEAS, aldosterone, followed by adrenocorticotropic to rule out Congenital Adrenal Hyperplasia (CAH), Cushing’s syndrome and tumor of the adrenal gland or ovaries in rare cases.
• Thyroid-stimulating hormone and thyroxine to rule out hyperthyroidism or hypothyroidism.
• Prolactin to rule out hyperprolactinaemia.
• Insulin-like growth factor-1 (IGF-1) and Oral Glucose Tolerance Test (OGTT) to rule out acromegaly.
• Suppression test of serum testosterone (using a GnRH agonist) if serum testosterone > 120 ng/dl, to test for ovarian hyperthecosis.

Please ask your doctor or the laboratory how to correctly prepare for these tests.

However, in cases of normal androgens but irregular periods and no other conditions, an ultrasound scan is necessary to confirm whether or not you have polycystic ovaries (i.e. Type D PCOS).

Finally, to obtain a complete picture of your condition, the doctor should also check your cholesterol, glucose and insulin levels. This is to check for insulin resistance, type 2 diabetes and dyslipidemia, which is common in women with PCOS.

Defining PCOS according to BMI (normal, overweight, obese) and glucose metabolism (normal, insulin resistant, diabetes) effectively means there are 36 subtypes of PCOS.

On the other hand better defined PCOS helps doctors and patients choose a treatment option much more likely to have a positive impact on their condition.