When is pcos diagnosed

Patients with PCOS most commonly present with signs of hyperandrogenism and a constellation of oligomenorrhea, amenorrhea, or infertility. The diagnostic workup should begin with a thorough history and physical examination. Clinicians should focus on the patient's menstrual history, any fluctuations in the patient's weight and their impact on PCOS symptoms, and cutaneous findings e.

The Endocrine Society advises clinicians to diagnose PCOS using the Rotterdam criteria Table 1 19 , although recommendations differ across guidelines. Information from reference Diagnosis can generally be accomplished with a careful history, physical examination, and basic laboratory testing, without the need for ultrasonography or other imaging.

Hyperandrogenism can be diagnosed clinically by the presence of excessive acne, androgenic alopecia, or hirsutism terminal hair in a male-pattern distribution ; or chemically, by elevated serum levels of total, bioavailable, or free testosterone or dehydroepiandrosterone sulfate.

Ovulatory dysfunction refers to oligomenorrhea cycles more than 35 days apart but less than six months apart or amenorrhea absence of menstruation for six to 12 months after a cyclic pattern has been established. A polycystic ovary is defined as an ovary containing 12 or more follicles or 25 or more follicles using new ultrasound technology measuring 2 to 9 mm in diameter or an ovary that has a volume of greater than 10 mL on ultrasonography.

A single ovary meeting either or both of these definitions is sufficient for diagnosis of polycystic ovaries. The goal of further evaluation of suspected PCOS is twofold: to exclude other treatable conditions that can mimic PCOS and to detect and treat long-term metabolic complications. Anovulation is common after menarche, so it is reasonable to delay workup for PCOS in adolescents until they have been oligomenorrheic for at least two years.

The differential diagnosis of PCOS is broad and includes both endocrinologic and malignant etiologies. Figure 1 19 provides an algorithm for the workup of select presentations. For any woman with suspected PCOS, the Endocrine Society recommends excluding pregnancy, thyroid dysfunction, hyperprolactinemia, and nonclassical congenital adrenal hyperplasia. In women with rapid symptom onset or significant virilization, such as deepening voice or clitoromegaly, an androgen-secreting tumor should be ruled out.

Finally, Cushing syndrome or acromegaly should be excluded in patients with physical findings that suggest either condition. Diagnosis of polycystic ovary syndrome. A ratio greater than 2 generally indicates PCOS, but there are no exact cutoff values because many different assays are used.

PCOS is a multifaceted syndrome that affects multiple organ systems with significant metabolic and reproductive manifestations. Treatment should be individualized based on the patient's presentation and desire for pregnancy Figure 2 19 , 29 — Devices and medications used to treat manifestations of PCOS, and their associated adverse effects, are described in Table 2. Management of polycystic ovary syndrome. Treatment options vary depending on patient's desire for contraception.

Lifestyle modification is a central part of treatment for all manifestations of polycystic ovary syndrome. Information from references 19 , and 29 through Infertility first-line therapy Multiple pregnancy or ovarian hyperstimulation, thromboembolism, visual disturbances. Mild hirsutism second-line therapy Hirsutism weak recommendation because of inconsistent study results Hirsutism safe and effective according to low- to very low-quality evidence Menstrual irregularities, hirsutism, acne first-line therapy 19 , 30 , Nonsteroidal competitive inhibitor of aromatase; inhibits conversion of adrenal androgens.

Infertility first-line therapy 19 , Amenorrhea, nausea, vomiting; rare complications include the device becoming embedded in the myometrium and uterine perforation. Abnormal uterine bleeding FDA approved Menstrual irregularities second-line therapy added to hormonal contraceptives. Hirsutism third-line therapy added to hormonal contraceptives and spironolactone Hirsutism second-line therapy added after 6 months of oral contraceptive therapy if not improved 32 , Acne second-line therapy.

Adapted with permission from Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician. A team approach involving care by primary care and subspecialist physicians can be helpful to address the multiple manifestations of the syndrome. Goals for treatment e. Metabolic complications should be addressed in every patient via a blood pressure evaluation, a lipid panel, and a two-hour oral glucose tolerance test. Patients who are overweight should be evaluated for signs and symptoms of obstructive sleep apnea.

All patients should be screened for depression Figure 1 Lifestyle modification and weight reduction reduce insulin resistance and can significantly improve ovulation. Therefore, lifestyle modification is first-line therapy for women who are overweight. Recent studies suggest that letrozole is associated with higher live-birth rates and ovulation rates compared with clomiphene in patients with PCOS.

In a patient not seeking pregnancy, the Endocrine Society recommends hormonal contraception i. Prevention of endometrial hyperplasia from chronic anovulation may be accomplished either by progesterone derivatives, progestin-containing oral contraceptives, or the levonorgestrel-releasing intrauterine system Mirena.

Hirsutism is a bothersome hyperandrogenic manifestation of PCOS that may require at least six months of treatment before improvement begins. According to a Cochrane review, the most effective first-line therapy for mild hirsutism is oral contraceptives.

Any of these can be used as monotherapy in mild cases or as adjunctive therapy in more severe cases. Acne is common in the general population and in patients with PCOS.

Hormonal contraceptives are first-line medications for treating acne associated with PCOS and can be used in conjunction with standard topical acne therapy e.

More research is needed to clarify the complex pathophysiology of PCOS. No single test is currently available for its diagnosis. Additionally, once diagnosis is established, the options for treatment are of limited number and effectiveness because they target only the symptoms of PCOS.

Finally, patients with PCOS have higher rates of metabolic complications, such as cardiovascular disease, but their impact on mortality is not clear. Therefore, more prospective epidemiologic studies on the topic are necessary. Data Sources : PubMed, the Cochrane database, UpToDate, and Dynamed were searched using the key terms polycystic ovarian syndrome, metabolic syndrome, infertility, and diagnosis and treatment. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews.

Search dates: April and March This review updates previous articles on this topic by Richardson 35 ; Radosh 36 ; and Hunter and Sterrett. Already a member or subscriber? Log in. Your doctor can talk with you about ways to help you ovulate and to raise your chance of getting pregnant.

You can also use our Ovulation Calculator to see which days in your menstrual cycle you are most likely to be fertile. Yes and no. PCOS affects many systems in the body. Many women with PCOS find that their menstrual cycles become more regular as they get closer to menopause. Also, the risks of PCOS-related health problems, such as diabetes, stroke, and heart attack, increase with age.

These risks may be higher in women with PCOS than those without. There is no single test to diagnose PCOS. To help diagnose PCOS and rule out other causes of your symptoms, your doctor may talk to you about your medical history and do a physical exam and different tests:. Once other conditions are ruled out, you may be diagnosed with PCOS if you have at least two of the following symptoms: 5.

You and your doctor will work on a treatment plan based on your symptoms, your plans for having children, and your risk of long-term health problems such as diabetes and heart disease. Many women will need a combination of treatments, including:. Read more about treating infertility in PCOS. PCOS can cause problems during pregnancy for you and for your baby. Women with PCOS have higher rates of: 6. Your baby also has a higher risk of being heavy macrosomia and of spending more time in a neonatal intensive care unit NICU.

Department of Health and Human Services. ET closed on federal holidays. Breadcrumb Home A-Z health topics Polycystic ovary syndrome. Polycystic ovary syndrome. Polycystic ovary syndrome Polycystic ovary syndrome PCOS is a health problem that affects 1 in 10 women of childbearing age. What is polycystic ovary syndrome PCOS? PCOS can cause missed or irregular menstrual periods. Irregular periods can lead to: Infertility inability to get pregnant. In fact, PCOS is one of the most common causes of infertility in women.

Development of cysts small fluid-filled sacs in the ovaries. Who gets PCOS? What are the symptoms of PCOS? Women with PCOS may miss periods or have fewer periods fewer than eight in a year. Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods. Too much hair on the face, chin, or parts of the body where men usually have hair.

This is called "hirsutism. What causes PCOS? Most experts think that several factors, including genetics, play a role: High levels of androgens. Androgens are sometimes called "male hormones," although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than normal. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg ovulation during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.

High levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body's cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who have overweight or obesity, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes usually type 2 diabetes. Over time, insulin resistance can lead to type 2 diabetes.

Is PCOS linked to other health problems? More than half of women with PCOS will have diabetes or prediabetes glucose intolerance before the age of High blood pressure. High blood pressure is a leading cause of heart disease and stroke. Learn more about heart disease and stroke. Back to Polycystic ovary syndrome. The GP will ask about your symptoms to help rule out other possible causes, and check your blood pressure.

They'll also arrange for you to have a number of hormone tests to find out whether the excess hormone production is caused by PCOS or another hormone-related condition. You may also need an ultrasound scan , which can show whether you have a high number of follicles in your ovaries polycystic ovaries.

The follicles are fluid-filled sacs in which eggs develop.