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Polycyctic Ovary Syndrome (PCOS)

The diagnosis of PCOS can be made on history and obvious clinical features without any blood tests.

Once the diagnosis of PCOS is made, an effective working relationship should be established between the patient and a healthcare provider who has an interest in PCOS. This will insure that as new information and treatments become available they will be discussed with and offered to the patient. We anticipate significant new advances will be made in the upcoming years to unravel the etiology and provide effective target specific therapies for PCOS. PCOS should be considered a treatable disorder.

PCOS affects about 5% of the female population and is the cause of anovulation in nearly half of anovulatory women. A reproductive endocrinologist, because of the population of patients seen, becomes adept at recognizing classical features of PCOS. PCOS is characterized by ovarian and possibly adrenal androgen (male hormone) excess, additional metabolic abnormalities (cardiovascular disease, non-insulin dependent diabetes, endometrial carcinoma, obesity, dysfunctional uterine bleeding, infertility), and appears to have a hereditary predisposition.

Clinical features which are found in patients with PCOS include: oligoovulation (cycle duration greater than 35 days and or less than eight cycles per year) (90%); hirsutism (male hair patterns) (70-80%); polycystic ovaries by ultrasound (pearl necklace or string of pearls sign) (70-80%); android obesity also referred to as trunkal obesity (above the waist accumulation of excess weight) (50-60%); male pattern baldness (temporal and crown of head hair loss) (20-25%); and acne (15-20%). Thus the findings noted above often reveal the diagnosis of PCOS without blood tests.

Laboratory tests are occasionally performed to rule out other potential abnormalities. Some laboratory tests which may be drawn to complete the evaluation include: prolactin, thyroid stimulating hormone (TSH), 17- hydroxyprogesterone, DHEAS, and glucose and insulin levels, and cortisol levels. Some laboratory values which confirm the clinical diagnosis of PCOS include: decreased sex hormone binding globulin, elevated bioavailable testosterone, elevated androsteinedione levels, LH/FSH ratio >2.5, elevated DHEAS, and elevated total testosterone levels. Your physician will determine which laboratory evaluations are most appropriate for you.

The diagnosis of PCOS is important to determine because there are numerous medical interventions which may significantly improve the patients cosmetic and metabolic complaints and improve their long term health. Such medications include oral contraceptive agents, GnRH agonists, insulin lowering agents, spironolactone, and other antiandrogens. The University of Utah has ongoing clinical studies on the inheritance of this disorder that your physician advise you about.