Polycystic Ovaries (PCOS): Symptoms, Diagnosis and Treatment
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, and it is estimated that about one woman in ten has it. Despite the name, these are not true cysts: the ultrasound shows numerous small follicles that have not matured to ovulation. PCOS is recognized by irregular cycles, signs of an excess of male hormones and the appearance of the ovaries, and it often goes together with insulin resistance. This article explains the symptoms, how the diagnosis is made, which tests are done, what is ruled out and what PCOS means for pregnancy.
Symptoms of polycystic ovaries
- irregular or infrequent cycles, more than 35 days apart, or fewer than eight cycles a year;
- no period for several months;
- increased hair growth on the face, chest and abdomen;
- acne that persists beyond puberty;
- thinning hair on the crown;
- weight gain, especially around the waist, and difficulty losing it;
- darker, velvety patches of skin on the neck and under the arms, a sign of insulin resistance;
- difficulty becoming pregnant.
Not all the symptoms have to be present. Some women have only irregular cycles, and some have regular cycles with marked acne and hair growth.
How the diagnosis is made
In adult women the diagnosis is made when two of three criteria are present, once other causes have been ruled out:
| Criterion | How it is checked |
|---|---|
| Irregular or absent ovulation | The history of the cycles, and if needed tracking ovulation by ultrasound |
| Signs of excess androgens | Examination of the skin and hair growth, and hormones: testosterone and other androgens |
| Polycystic appearance of the ovaries | Gynecological ultrasound: 20 or more follicles in one ovary or an enlarged ovary. Under newer guidelines, in adult women AMH can serve instead of ultrasound. |
What is ruled out before the diagnosis
Irregular cycles and excess androgens are also produced by thyroid disorders, a raised prolactin, rare disorders of the adrenal gland and, of course, pregnancy. That is why TSH and prolactin are checked alongside the ovarian hormones, and 17-OH progesterone where the doctor judges it necessary.
Tests when PCOS is suspected
- Hormones: LH, FSH, estradiol, testosterone and SHBG, in women who have a cycle usually on days 2 to 5 of the cycle;
- ruling out other causes: TSH, prolactin, and 17-OH progesterone if needed;
- AMH, which in PCOS is often raised;
- metabolism: fasting glucose and insulin (HOMA-IR), HbA1c or a glucose tolerance test, and a lipid panel.
Hormone reference ranges depend on the phase of the cycle and on the laboratory, so a result is read against the range printed beside it.
PCOS and insulin resistance
Insulin resistance is present in a large proportion of women with PCOS, including those of normal weight. An excess of insulin pushes the ovaries to make more androgens, and the androgens further disrupt ovulation, so the circle closes. That is why assessing blood sugar and insulin is part of the work-up. In women carrying extra weight, losing five to ten percent of body weight often brings back more regular cycles and ovulation.
Treatment and pregnancy
Treatment is chosen according to the goal: regulating the cycle, acne and hair growth, or pregnancy. The foundation is diet, physical activity and sleep, and medication is prescribed by a gynecologist or an endocrinologist according to the results. PCOS does not mean infertility. Most women with PCOS do become pregnant, sometimes with ovulation tracked by follicle scans and with treatment that encourages ovulation.
In the long term PCOS carries a higher risk of type 2 diabetes, raised blood lipids and thickening of the lining of the womb when cycles are absent for long periods, so regular check-ups are recommended even when there is no wish to become pregnant.
What an appointment at Miren Medic looks like
The gynecological appointment with ultrasound at the Miren Medic clinic is carried out by Prof. Dr Snežana Rakić, specialist in gynecology and obstetrics, Prim. Dr Radojka Cerović-Popović and Dr Miljan Čuljić. Hormone and metabolic tests are run in the clinic laboratory, and with marked insulin resistance or a thyroid disorder the endocrinologist Dr Nemanja Nenezić joins the work-up. Tracking ovulation by follicle scans is also done at the clinic. All of it without a referral.
Prices
| Service | Price |
|---|---|
| Gynecological appointment + ultrasound (Dr Miljan Čuljić) | 12.000 RSD |
| Gynecological appointment (Dr Radojka Cerović Popović) | 10.000 RSD |
| Gynecological ultrasound (Dr Radojka Cerović Popović) | 8.000 RSD |
| Follicle scan | 6.000 RSD |
| Endocrinology appointment (Dr Nemanja Nenezić) | 12.000 RSD |
Frequently asked questions
What are polycystic ovaries?
Ovaries in which many small follicles are seen that have not matured to ovulation. The appearance of the ovaries is not in itself a disease; we speak of polycystic ovary syndrome only when irregular cycles or signs of excess androgens come with it.
What are the first symptoms of PCOS?
Most often irregular or infrequent cycles, then acne, increased hair growth and weight gain around the waist. In many women PCOS is only discovered when they are trying to become pregnant.
Can a woman with PCOS become pregnant?
She can. Most women with PCOS do become pregnant, sometimes spontaneously, and sometimes with weight management, ovulation tracking and treatment that encourages ovulation, prescribed by a doctor.
Which tests are done for polycystic ovaries?
The hormones LH, FSH, estradiol, testosterone and SHBG, then TSH and prolactin to rule out other causes, AMH, and glucose, insulin, HbA1c and a lipid panel. A gynecological ultrasound is done alongside the tests.
Does PCOS go away?
PCOS does not disappear, but the symptoms can be well controlled, and in many women the cycles become more regular with age. The metabolic risk remains, so checks of blood sugar and lipids matter later on too.
Is PCOS linked to insulin resistance?
It often is, including in women of normal weight. Insulin resistance increases the production of androgens and disrupts ovulation, so it is checked in every woman with PCOS.
Book an appointment
If your cycles are irregular or you suspect polycystic ovaries, book a gynecological appointment with ultrasound at the Miren Medic clinic. The examination, the ultrasound and the hormone tests come from one place, without a referral.
