PCOS Doctor Diagnosis and Testing Options

Each woman’s experience of Polycystic Ovary Syndrome (PCOS) is unique because no two women have the exact same symptoms. The current agreed upon diagnostic criteria for PCOS is meeting at least two of the following three criteria:

1. Irregular or absent periods

2. Biochemical or physical signs of hyperandrogenism (high androgens) without another medical cause

3. A string of small follicles on an ultrasound

Physical Exam and Medical History
The doctor will want to do a complete physical and pelvic exam. He or she will look for physical signs of high androgens or testosterone like abnormal hair growth (specifically on the face, lower abdomen, back, and chest), acne, skin tags, male pattern baldness and acanthosis nigricans (darkened thick skin on the neck, thighs, armpits or vulva).

When a woman has infrequent, absent or irregular periods (8 or fewer menstrual cycles in a year), it is a sign that ovulation may not be occurring and could indicate PCOS. The doctor will try to rule out other conditions that could cause irregular periods, such as thyroid disease, hyperprolactinemia, Cushings syndrome or congenital adrenal hyperplasia. It is important to note that women with PCOS can have a monthly menstrual cycle and have PCOS. 

The doctor will ask you about any unusual symptoms you may have noticed, so make sure to mention any of your concerns. Writing a list before you go may help you remember important points to ask about. You will be asked about your menstrual periods; how regular they are and the length of time between them. This may help your doctor determine if you are ovulating.

A transvaginal ultrasound may or not be performed to rule out PCOS. In a transvaginal ultrasound probe is placed inside the vagina, which allows the physician to examine the reproductive organs and look for abnormalities. The thickness of the endometrium can be measured. A criterium for PCOS includes the presence of 12 or more small (2 to 9 mm) follicles in each ovary. Often times these follicles are called "cysts". There are many women who have cystic-appearing ovaries without symptoms of hyperandrogenism, and many women who have been diagnosed with PCOS who do not have classically cystic ovaries. Some doctors find the use of a transvaginal ultrasound in adolescents unnecessary. 

Finally, blood work will most likely be taken. Besides hormonal testing, like for testosterone, other sex hormones should be checked such as follicle stimulating hormone, luteinizing hormone and prolactin, Your doctor may test for other associated conditions like high cholesterol and insulin resistance. A new hormonal blood test, looking at a woman's AMH (Anti-Mullerian Hormone) is now being used by some physicians as a diagnostic tool as well.

An endometrial biopsy can be performed to determine if your endometrial tissue is in the correct phase or to test for endometrial cancer. This risk of endometrial cancer increases with the number of and length of time between missed periods. The biopsy can be done in your doctor’s office and is relatively painless, although you may experience minimal cramping during the procedure. A small amount of tissue is removed from your uterus through a thin catheter placed into through the cervix and into the uterus. This tissue is then analyzed in the context of your cycle and examined for cancer cells.

While this may all seem overwhelming, remember that you are not alone. As the most common endocrine disorder among women of childbearing age, there are many women with PCOS who have been through this. Reach out to a support group and the people who care about you. Following your doctor's advice and learning about your disease is the best way to manage it.

Sources:

Grassi A. PCOS: The Dietitian's Guide. 2nd edition. Luca Publishing. Bryn Mawr, PA. 

Jensen, Jani R. and Ruben Alvero. "Polycystic Ovarian Syndrome." Reproductive Endocrinology and Infertility: The Requisites in Obstetrics and Gynecology. Ed. Mark Evans, MD. Philadelphia: Mosby, 2007. 65-75.