How Do You Know If It’s PCOS?

What is PCOS?

Polycystic Ovarian Syndrome — PCOS  is a hormonal imbalance that affects women during their childbearing years (ages 15 to 44). Between 2.2 and 26.7 percent of women in this age group have PCOS. Many women have PCOS but don’t know it. The cause of PCOS is a combination of genetic and environmental factors including lifestyle and nutrition.

What are the defining symptoms?

Irregular menstrual cycles (typically longer, though not always)

• Ann-ovulation (lack of ovulation)
• Elevated androgens (testosterone, DHEA-S, androstenedione)

The above causes one or more of:

• Acne (chest, back, face)
• Hair loss
• Hair growth (chin, chest, abdomen)
• Weight gain
• Fertility challenges
  
  

How is PCOS diagnosed?

It’s important to note, as a Nutritionist it is out of my scope of practice to diagnose PCOS or any other condition. If I suspect one of my clients has PCOS, I refer them to a GP or if I suspect PCOS has been incorrectly diagnosed then I do ask that they seek a second opinion.

Currently The Rotterdam Criteria (below), is used to diagnose PCOS:

• Annovulation – irregular periods
• High androgens (testosterone, DHEA-S, androstenedione)
• Polycystic ovaries on ultrasound.

In order to get a diagnosis of PCOS you need to meet 2 out of 3 of the criteria.

This is confusing because you can have ‘polycystic ovaries’ and NOT have PCOS and you can have PCOS and NOT have polycystic ovaries.

What’s referred to as ‘cysts’ on the ovaries are immature ovarian follicles, which any women can have. Prior to ovulation or in an attempt to reach ovulation, many follicles will attempt to become the dominant follicle, which would then go on to ovulate — this is normal, and this is what is being seen as ‘cysts’ on the ovaries. The key takeaway here is that PCOS cannot be diagnosed with ultra-sound alone, and perhaps this shouldn’t be included at all in the criteria — and on this note, the name needs changing too.

A better definition, I believe now being used by PCOS researchers is — “High androgens when all other possible causes of high androgens have been ruled out.”

What else could cause symptoms that look like PCOS?

• Hypothalamic Amenorrhea (HA) – absent menstrual cycle due to miscommunication between hypothalamus and the ovaries.

• Congenital Adrenal Hyperplasia – a genetic condition that accounts for ~9% of PCOS cases. You can ask your GP to test for this.
• Underlying Thyroid conditions – hypothyroidism and autoimmune thyroid conditions can cause similar symptoms to PCOS. Note: It is possible to have an underlying thyroid condition without having any overt symptoms. Ask your GP to test: TSH, T4, T3, RT3, TPO, Tg Ab.
  
  

What causes PCOS?

The most common:

• Insulin Resistance: accounting for ~80% of all PCOS cases and ~60% of lean PCOS. You can be lean and have insulin resistance.

Other possible causes:

• Adrenal PCOS: caused by chronic stress. You will have high DHEA-S rather than testosterone.
• Post-Pill PCOS: due to a temporary surge in androgens – similar to what happens to many girls when they begin to menstruate.
• Inflammatory PCOS: due to e.g. chronic gut infections. Stimulating the ovaries to make testosterone.
  
  

If you suspect PCOS, I suggest asking for these tests:

*Hormones: testosterone, DHEA-s, LH, FSH, prolactin, estrogen, progesterone.

*Insulin Resistance: insulin assay – if this is not available fasting insulin but this isn’t as sensitive.

*Thyroid Markers: TSH, T4, T3, RT3, TG Ab, TPO Ab.

*Inflammatory Markers: CRP, homocysteine (this is basic).

*Micronutrients: Vitamin D, B12, folate, iron, zinc.

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