Polycystic Ovary Syndrome (PCOS) and Polycystic Ovary Disorder (PCOD) are common yet often misunderstood conditions affecting women of reproductive age. Characterised by hormonal imbalances, irregular menstrual cycles, and the presence of ovarian cysts, these disorders can significantly impact a woman’s health and quality of life. Therefore, the condition has to be accurately diagnosed to provide effective treatment. This article delves into the various methods used to diagnose PCOS and PCOD, providing a comprehensive understanding of these conditions.

Clinical Evaluation

The first step in diagnosing PCOS/PCOD is a thorough clinical evaluation. This includes a detailed physical examination and understanding your medical history. The doctor will inquire about menstrual cycle irregularities, weight changes, and any symptoms of excess androgen, such as hirsutism (excess hair growth) and acne. The physical examination may include checking for signs of insulin resistance and measuring body mass index (BMI).

A comprehensive clinical evaluation helps in identifying potential red flags and ruling out other conditions that could mimic PCOS/PCOD, such as thyroid disorders, hyperprolactinemia, or adrenal hyperplasia. The clinician may also discuss family history, as PCOS/PCOD can have a genetic component and lifestyle factors.

Hormonal Testing

Tests done to determine blood hormone levels can also help diagnose PCOS/PCOD. These tests include:

• Androgens: Elevated levels of androgens (male hormones) like testosterone and DHEA-S are common in women with PCOS/PCOD. These hormones contribute to symptoms such as hirsutism, acne, and alopecia.
• Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH): An increased LH to FSH ratio is often indicative of PCOS. Normally, the ratio of these hormones is around 1:1, but in PCOS, the ratio can be 2:1 or higher.
• Insulin and Glucose Levels: Insulin resistance is a hallmark of PCOS. High insulin levels can exacerbate androgen production and disrupt hormonal balance.
• Thyroid Function Tests: This test helps to rule out thyroid disorders as they can mimic PCOS/PCOD. Thyroid dysfunction affects the menstrual cycle.
• Prolactin Levels: High prolactin levels can cause menstrual irregularities, anovulation, and infertility.

Pelvic Ultrasound

A pelvic ultrasound is a crucial diagnostic tool for PCOS/PCOD. This imaging test allows for the visualization of the ovaries and the endometrium (lining of the uterus). During a transvaginal ultrasound, a small probe is inserted into the vagina to get a clearer view of the reproductive organs. Key features that may indicate PCOS/PCOD include:

• Multiple Ovarian Cysts: Refers to the presence of 12 or more small follicles (2-9 mm in diameter) in each ovary. These cysts are actually immature follicles that have failed to ovulate.
• Increased Ovarian Volume: The volume of an ovary in PCOS is typically greater than 10 cubic centimeters.
• Thickened Endometrium: The lining of the uterus may be thicker than usual due to irregular shedding during menstrual cycles.

Ultrasound findings, combined with clinical and hormonal assessments, provide a comprehensive picture of the ovarian morphology and help in confirming the diagnosis.

Rotterdam Criteria

The Rotterdam Criteria is a widely accepted diagnostic guideline for PCOS. A woman is diagnosed with PCOS if two out of the three conditions given below are met:

• Oligo- or Anovulation: Irregular or absent menstrual cycles.
• Hyperandrogenism: Clinical signs (e.g., hirsutism, acne) or biochemical evidence (elevated androgen levels) of excess male hormones.
• Polycystic Ovaries: As evidenced by ultrasound.

It is important to note that other potential causes for these symptoms must be ruled out before confirming a PCOS diagnosis. This criterion ensures a standardized approach, facilitating accurate diagnosis and appropriate management across different clinical settings.

Additional Diagnostic Tools

In some cases, additional tests and assessments may be necessary to gain a complete picture of a patient’s health. These can include:

• Lipid Profile: To check cholesterol levels as women with PCOS/PCOD are at a higher risk of cardiovascular disease. Elevated levels of LDL cholesterol and low levels of HDL cholesterol are common findings.
• Blood Pressure Measurement: High blood pressure is another common complication. Regular monitoring is essential to prevent long-term cardiovascular risks.
• Glucose Tolerance Test: To evaluate how the body processes sugar and identify any insulin resistance. It involves determining blood glucose levels prior to and after having a glucose-rich drink.
• Endometrial Biopsy: In cases of prolonged menstrual irregularities, a biopsy of the uterine lining may be performed to rule out endometrial hyperplasia or cancer. This is particularly important in women with prolonged periods of amenorrhea (absence of menstruation).

Diagnosing PCOS and PCOD requires a multifaceted approach that includes clinical evaluation, hormonal testing, imaging, and adherence to established diagnostic criteria. Early and accurate diagnosis is essential for managing symptoms, preventing complications, and improving overall quality of life. If you suspect you have PCOS/PCOD, consult with a healthcare provider who can guide you through the diagnostic process and develop a personalized treatment plan.

Aanvi Fertility and Women’s Centre

At Aanvi Fertility and Women’s Centre, we pride ourselves on being the best in diagnosing and treating women’s health problems. Our team of experienced specialists utilizes advanced diagnostic techniques and a holistic approach to provide comprehensive care for conditions like PCOS and PCOD. They will help you regain your health. Call us today and book an appointment!