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Types of Diagnosis
Types of Diagnosis
A series of tests can be conducted to pinpoint PCOS. Follow along below to see how
Physical Exams¹⁴
Physical Exams¹⁴
Pelvic exams - conducted by inspection of the external genital area (vulva). A lubricated speculum, plastic or metal, is then gently inserted into the vagina. The physician then inserts 1-2 gloved, lubricated fingers into the vagina while the other hand presses gently on the lower abdomen
Transvaginal ultrasound - a sterile, lubricated probe (transducer), about the size of a tampon, is inserted into the vagina and emits sound waves that bounce off internal structures, creating detailed images on a screen
Ultrasounds - the transducer emits high-frequency sound waves that travel through the body and bounce off tissues, fluids, and organs which get converted into real-time images
Pelvic Exam
Pelvic Exam
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Transvaginal Ultrasound
Transvaginal Ultrasound
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Ultrasounds
Ultrasounds
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Image formulated by ChatGPT
External Examinations¹¹
External Examinations¹¹
Blood tests - can measure hormone levels, if there is an excessive amount of “male hormones” will become present
Physical exams - include checking signs of excess hair growth, insulin resistance, and acne
Rotterdam Criteria
Rotterdam Criteria
The Rotterdam Criteria is used to diagnose PCOS in which you must have at least two out of the three symptoms.
Irregular/Absent Ovulation: either long cycles, fewer than 8 periods/year or no ovulation at all - Anovulation
Hyperandrogenism: due to elevated testosterone or androgen levels in the blood. This causes hirsutism the excessive hair growth.
Polycystic ovaries on Ultrasound: an indicator for PCOS would be if 12 or more cysts were viewed in one or both ovaries.
The simplified criteria was given by ChatGPT 4.0
Cyst formation
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Difficulties in Diagnosis
Difficulties in Diagnosis
PCOS is often a difficult hormonal imbalance to pinpoint as some of the symptoms are very similar to other female issues such as:
Irregular menstrual cycles in adolescents: At a young age, female ovulation is often irregular and is therefore not seen as something alarming
Influence of birth control: Many individuals take oral contraceptives which regulate menstrual cycles and lower androgens, potentially making PCOS symptoms
Weight-related bias: Many people with PCOS have insulin resistance and weight gain, but lean PCOS exists and is often overlooked
Polycystic ovaries are not exclusive to PCOS: Some individuals without PCOS have cystic-appearance ovaries on ultrasound, making imaging alone insufficient for diagnosis
Comorbidities masking symptoms: Conditions like hypothyroidism, diabetes, and adrenal disorders can mimic or contribute to PCOS symptoms, complicating diagnosis
No single definitive test: take the Rotterdam Criteria as an example
Varied symptoms: PCOS presents differently in each individual. From irregular periods to acne issues, weight gain, or excess hair growth, individuals with PCOS could suffer from a variety of issues
The list of difficulties in diagnosis was given by ChatGPT 4.0
Treatments for PCOS
Treatments for PCOS
PCOS is a condition which unfortunately does not currently have a known cure⁴.
Any and all treatments and medications are aimed towards reducing the severity and impact of the specific symptom affecting the patient¹³⁴. Most often, doctors will suggest lifestyle changes as the easiest means to control symptoms⁴.
Image formulated by ChatGPT
Image formulated by ChatGPT
Lifestyle Changes:
Maintaining a healthy, low calorie diet³⁴
limits carbohydrates that can elevate insulin levels even more
encourages consumption of complex carbohydrates that raise blood sugar levels slowly (eg. fruits, vegetables, whole grains, cooked dry beans, peas)
Having an active lifestyle¹³⁴
maintains a healthy weight which is important to reduce the risk of type 2 diabetes, a side-effect much more common in patients predisposed to PCOS
can lower insulin and androgen levels, preventing insulin resistance
seen to restore ovulation patterns in certain cases
That being said, there are a plethora of medications and combination treatments which may also be implemented and will vary from patient to patient³.
Below are listed a few common treatments, organized by the symptom they are geared towards reducing:
Irregular Menstrual Cycles
Irregular Menstrual Cycles
Combined Oral Contraceptives (COCs)³:
most commonly prescribed therapy
suppresses ovulation and regulates cycles
Progesterone Therapy³:
induces withdrawal bleeding to prevent endometrial hyperplasia
Metformin³:
restores ovulation by lowering insulin levels
Inositols³:
normalizes ovarian functions
Clomiphene Citrate³:
stimulates ovulation by increasing FSH
Gonadotropins (FSH & LH injections)³:
directly stimulates egg production via injected hormones when oral medications fail
Ovarian Drilling (Surgical)³:
helps restore ovulation in Clomiphene-resistant cases
Hirsutism, Acne, Hair Loss
Hirsutism, Acne, Hair Loss
Combined Oral Contraceptives (COCs):
Increase SHBG, reducing free testosterone².
Spironolactone:
Blocks androgen receptors, reducing oil production and hair growth².
Finasteride & Flutamide:
Block DHT production, slowing hair loss and excess hair growth².
Eflornithine Cream:
Slows facial hair regrowth².
Ovarian Drilling:
Lowers ovarian androgen production².
Inflammation & Overall Chronic Symptoms
Inflammation & Overall Chronic Symptoms
Low-Dose Naltrexone (LDN):
Reduces chronic inflammation³⁴.
Statins:
Lower cholesterol and systemic inflammation³⁴.
Insulin Resistance & Metabolic Issues
Insulin Resistance & Metabolic Issues
Metformin³:
Improves insulin sensitivity and lowers insulin levels
Inositols³:
Improve glucose uptake and insulin function
GLP-1 Receptor Agonists³:
Reduce insulin resistance and aid weight loss
Low-Dose Naltrexone (LDN)³:
May improve insulin sensitivity
Statins³:
Lower inflammation and insulin resistance in PCOS
The list of treatments was organized by ChatGPT.
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