PCOS: How is it diagnosed?

Polycystic ovarian syndrome (PCOS) is one of the most common causes of infertility in women. This is because one of the main symptoms of PCOS is ovulation problems. This syndrome also contributes to a range of other health problems, all of which can fortunately be managed with the right diagnosis and treatment.

In this article, we find out exactly what PCOS is, what the symptoms are and how it is diagnosed, so the right treatment can be provided.

What is PCOS?

The name ‘polycystic ovarian syndrome’ is often frightening to hear, because it sounds as if it refers to cysts, which is misleading – PCOS does NOT mean there are cysts on the ovaries.

PCOS is actually an endocrine disease of the ovaries. It is a genetic disease and runs in families, and it is also a chronic medical condition for which there is no known cure. However, like other chronic medical problems such as asthma or diabetes, it can be well managed over the long term.

In simple terms, PCOS affects the little follicles in the ovaries in which potential eggs await the right hormonal signals to grow, after which they are released during ovulation. With PCOS, the little follicles are not stimulated to grow and to release every month.

What are the symptoms of PCOS?

PCOS is a leading cause of infertility, but it also produces with a range of other possible symptoms.

There are two reasons why PCOS affects fertility. The first is that one of the most common symptoms of PCOS is problems with ovulation. These problems range from no menstruation at all to irregular menstruation or very prolonged and heavy menstruation. The second reason is that PCOS could also cause recurrent miscarriages.

Further symptoms of PCOS includes skin problems, weight issues and associated health problems.

PCOS can cause problems with elevated levels of male hormones in a woman’s body, resulting in oily skin, acne and unwanted and abnormal hair growth. Women with PCOS could also have weight problems such as being overweight, gaining weight rapidly and difficulty to lose weight.

There are also possible associated health problems, especially problems with sugar metabolism and insulin levels, cholesterol and high blood pressure.

Another condition that has been associated with PCOS is obstructive sleep apnea. Some clues that you have this include your family or your partner complaining about excessive snoring or if you wake up in the mornings feeling exhausted.

Having noted all these possible symptoms, it is also important to understand that PCOS is a syndrome, so even if you are diagnosed with PCOS, it does not mean that you are destined to be overweight, struggling with unwanted hair growth and problem skin. PCOS is a syndrome that can express its symptoms in different ways.

Some patients don’t have any problems with their period, while others don’t struggle with excess hair or acne, and others don’t have weight problems. What this means is that PCOS can affect different women in different ways. In medical circles, specialists refer to this as the different phenotypes of polycystic ovarian syndrome.

How is PCOS diagnosed?

When diagnosing PCOS, our fertility experts at Cape Fertility use what is called the ‘Rotterdam’ criteria.

These are three different criteria for qualifying symptoms and results of the tests and investigations to determine if a woman has PCOS. If the results of the tests and investigations meet two of the three criteria, a diagnosis of polycystic ovarian syndrome is considered.

The first investigation is your menstrual cycle, since one of the most common symptoms is problems with ovulation. Investigating your cycle will require keeping track of your periods. You can use a variety of apps that are available on the App store on Google play, or you can even just jot the dates down in your diary.

A normal cycle is usually 21 to 35 days and it is expected that a woman would normally have at least eight periods in a year.

Signs of excess androgen levels – determined clinically and through blood tests – are the second of the three criteria used by our fertility experts at Cape Fertility.

Every woman needs to have androgens, including the most common form of androgen, which is testosterone. However, too many androgens circulating in your body can cause unpleasant symptoms. Elevated androgen levels might cause excess male pattern hair growth, such as a moustache or chin hair, hair on the nipples and excess hair on the back. It can also cause severe acne.

A blood test is also done to check the levels of the different androgens. If the test confirms raised levels of androgens, our fertility specialists will do further tests to look for alternative causes, as there are a few other possible causes other than polycystic ovaries. It is important to identify the cause, as this would affect the treatment required.

The third criteria for a diagnosis of PCOS is what the ovaries look like. Using state-of-the-art ultrasound technology, our fertility specialists will look at the little follicles – the little egg factories in each ovary – and count them on both ovaries. If there are a certain number, it might be said that the ovary has a polycystic appearance, but it still doesn’t mean you have PCOS.

Our fertility specialists at Cape Fertility will look at all three criteria to determine if your test results meet two out of the three criteria. If so, a diagnosis of PCOS will be considered.

Do I have PCOS?

While the symptoms of PCOS seem to be clear and straight-forward, the reality is that not all women with PCOS display all the symptoms, or even the same intensity of symptoms. In addition, some of the symptoms may be caused by a condition other than PCOS.

However, it is important to realise is that the symptoms of PCOS can substantially affect your quality of life, because it can have a great impact on your self-esteem, your body image and even your relationships.

The only way to know for certain whether you have PCOS is to undergo the necessary tests and investigations at an accredited and recognised clinic, where a fertility specialist with state-of-the-art equipment and years of experience will be able to make a professional determination as to whether the results of the tests and investigations meet two of the three Rotterdam criteria, and whether even this qualifies for a diagnosis of PCOS.

If you are diagnosed with PCOS, it is also important to realise that there are many ways to manage this chronic disease and even to achieve a pregnancy.

Weight loss is a cornerstone in the treatment of PCOS, and is beneficial both to prevent long term health problems and to increase the chance of conception. In fact, studies have shown that losing 5% of body weight is often enough to make a significant difference to PCOS symptoms, and will also increase the chance of conception. Fertility drugs are also effective, but this treatment should only be offered by qualified and registered fertility specialists and must be monitored very carefully.

If you suspect that you have PCOS, we would like to invite you to come and meet one of our specialists by clicking here

At Cape Fertility, we value each individual patient and we look forward to providing you with individualised and personalised care, affordable quality fertility treatment, and higher success rates at our purpose-built premises in the beautiful city of Cape Town.