Do I Really Have PCOS? Confirming the Diagnosis

Suspecting PCOS Quiz
Section 1: Menstrual Irregularities
Score 1 point for each item unless otherwise indicated

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When not on birth control pills, do you have or have you ever had any of the following problems:

__ Eight or fewer periods per year
__ No periods for an extended period of time (four or more months)
__ Irregular bleeding that starts and stops intermittently
__ Fertility problems
(Score 2 points if you have seen a fertility specialist or been treated with fertility drugs to induce ovulation.)

Section 2: Skin Problems
Score 1 point for each item unless otherwise indicated

__ Adult acne, or severe adolescent acne
__ Excess facial or body hair, especially upper lip, chin, neck, chest and/or abdomen
__ Skin tags
__ Balding or thinning hair
__ Dark or discolored patches of skin on your neck, groin, under arms or in skin folds
(Score 2 points if you answer yes to this question.)

Section 3: Weight Gain and Insulin-Based Problems
Score 1 point for each item unless otherwise indicated

__ Excess weight or difficulty maintaining weight
(Score 2 points if your excess weight is centered around your middle)
__ Sudden unexplained weight gain
__ Shaking, lack of concentration, uncontrollable hunger and/or mood swings two or more hours after a meal
__ Type 2 diabetes
(Score 2 points if you answer yes to this question)
__ Family history of type 2 diabetes, heart disease or hypertension

Scoring Results
0-4: Although PCOS is possible, it is much less likely for you than for those scoring higher.

5-9: If you are concerned about your health and score in this range you may want to consider talking to your doctor about the possibility of PCOS as well as other disorders.

10-15: PCOS is a syndrome, not a disease, and most women experience some but not all of the problems listed above. The majority of women who are diagnosed with PCOS score in this range. If you scored in this range you should see a doctor about the possibility that you have PCOS.

16-20: A score this high warrants urgent consultation with a doctor for PCOS or other endocrine-related disorders.

A PCOS diagnosis is made in several ways: medical history and examination, checking hormone levels, and an ultrasound.

It is important not to assume that you have PCOS, even if you have several of the symptoms. There may be other health conditions present that are creating problems. If you think you have PCOS or another health condition, make sure you consult a medical professional to confirm your suspicions. A PCOS diagnosis is made in several ways including medical history, physical examination, checking hormone levels, and, possibly, an ultrasound.

A health care professional should first take a complete medical history. He or she will ask questions about your menstrual history, including how old you were when you started your period, how long your cycles are, how much time passes between cycles, and how much you bleed in a cycle. Your health care provider will also ask about your reproductive history, including any pregnancies/miscarriages/abortions you have had, and birth control methods you are using or have used in the past. He or she will also ask about menstrual irregularities in other members of your family.

Your practitioner should also do a pelvic and physical exam. Make sure you inform your doctor of any additional symptoms you may have, including excess hair growth and skin abnormalities such as skin tags or dark patches on the neck, groin or under arms (which is called acanthosis nigricans). Your height, weight and blood pressure also will be checked.

A vaginal ultrasound also may be performed to check for multiple follicle cysts in your ovaries. This test is most commonly performed by fertility specialists and is less commonly done by general obstetricians and gynecologists. A probe is inserted in the vagina and the picture is shown on a screen beside the bed. A PCOS diagnosis cannot be made entirely on the basis of the ultrasound alone since not all women with PCOS have cysts.

This may seem contradictory. Why call it polycystic ovary syndrome when not all women have cysts? It is because PCOS was identified (originally as Stein-Leventhal Syndrome) many years ago based on the presence of cysts in the first known patients.

Conversely, not all women with cysts have PCOS. The presence of cystic ovaries does not always mean that you have the syndrome. At any given time, as many as 20 percent or more women have multiple cysts on their ovaries. However, ultrasound is still very helpful and, in combination with other tests, can help cement a firm diagnosis. Ultrasound also is used to measure the endometrial lining.

Since women with PCOS do not cycle normally, they may be at a higher risk for uterine lining cell changes and endometrial cancer. Measuring the endometrial lining can help a physician ascertain the health of your endometrium. Sometimes a biopsy of the lining is recommended.

If PCOS is suspected, your physician may recommend an extensive check of your endocrine system. This means some blood will be drawn to test your hormone levels. They will be looking for:

Luteinizing hormone (LH)
Follicle-stimulating hormone (FSH)
Total and free testosterone
Dehydroepiandrosterone sulfate (DHEAs)
Progesterone (20 to 30 days after the last period)
Patients with PCOS frequently have a high ratio of LH to FSH and elevated levels of testosterone. Originally considered an important marker for PCOS, the ratio of LH to FSH is now considered to be less useful in diagnosing the syndrome but is still of relevance to the overall picture. Additionally, women with irregular cycles and very high androgen levels should be screened for the possibility of adult-onset adrenal hyperplasia which can sometimes mask as PCOS. This is carried out with a blood test for the hormone 17-hydroxyprogesterone.

Other levels may be tested as well, including fasting glucose and insulin. Glucose and insulin tests are used to screen for conditions such as insulin resistance (IR) and type 2 diabetes. Many women with PCOS have insulin-based problems and research indicates that these problems appear to be at the root of the syndrome. If your fasting levels are normal, you may be asked to take an oral glucose challenge, also called an oral glucose tolerance test (OGTT). It is possible to have normal fasting levels and still have an underlying insulin problem that can be identified with the OGTT.

When administering an OGTT, your doctor should be particularly attentive to the results at the two-hour interval. Although other levels may be normal, women with PCOS often have abnormal findings at the two-hour interval.

The final test your doctor may order is a lipid panel. PCOS has recently been linked to heart disease. Women with PCOS frequently have high cholesterol and triglycerides. Elevated LDL, the “bad” cholesterol, is a common finding. Even women with normal total cholesterol may find that they have an unhealthy ratio of HDL to LDL. Recent studies seem to indicate that PCOS puts women at higher risk for cardiovascular disease, including early plaques (blockage in the arteries) and calcifications.

Your practitioner will make a PCOS diagnosis based on a combination of clinical observation and testing. Depending on your symptoms, your physician will determine which of the above tests are necessary. Once a diagnosis is obtained, you and your doctor will work together to decide on your treatment goals and proceed accordingly.