The term PCOS, Polycystic Ovary Syndrome, can be a confusing one for both women and healthcare professionals. In order to eliminate the confusion, and ensure women are given accurate diagnosis and treatment, the Endocrine Society has made an official recommendation that medical and healthcare professionals use two of the three Rotterdam criteria before making an official diagnosis of PCOS in their patients.
Endocrine Society recommends women diagnosed with 2 out of 3 symptoms be diagnosed with PCOS
The Rotterdam Criteria were set forth during a National Institute of Health (NIH) conference back in 1990. Experts at the conference determined that women with PCOS have three diagnosable conditions:
- An excess production of androgen (hyperandrogenism)
- Ovulatory dysfunction (oligoovulation)
- Multiple ovarian cysts (polycystic ovaries)
PCOS affects approximately 5 million American women, and is the leading cause of infertility, which necessitates women to pursue In Vitro Fertilization and other fertility treatments. The problem is that other medical conditions, like non-classical congenital adrenal hyperplasia, thyroid disease, and hyperprolactinemia have similar symptoms to PCOS, which can prolong diagnosis and, therefore, adequate treatment.
For this reason, the independent NIH recommends PCOS be diagnosed anytime when two of the three determining factors are present, and also that the name PCOS be changed to something more indicative of the complex nature of its symptoms.
The symptoms of polycystic ovary syndrome include:
- Infrequent, irregular, or nonexistent periods
- An inability to conceive due to lack of ovulation
- Excess hair growth (called hirsutism) on the face, back, chest, stomach and toes
- Thinning hair or male-patterned baldness
- Excess weight gain, especially around the middle
- Patches of thick, dark-colored skin on the neck, arms, breasts and thighs
- Skin tags
- Sleep apnea
- Depression or anxiety
If you have one or more of the above symptoms, speak with your healthcare provider immediately to begin the screening process.
The earlier PCOS is diagnosed, the better
Another goal of the panel is to begin diagnosing women with polycystic ovary syndrome as early as possible. Aggressive treatment of accurately diagnosed PCOS during adolescence has been shown to be more effective than when it is caught early on. In addition to improving the lives of younger women, widespread early treatment of PCOS could mean increasing a woman’s odds for a natural conception.
The panel had recommendations regarding the treatment protocol for women diagnosed with PCOS. These recommendations included:
- Hormonal contraceptives should be used as the first-line treatment for women who have PCOS, but not seeking to get pregnant.
- Women who are trying to get pregnant and are experiencing anovulatory infertility (i.e. they aren’t ovulating regularly) should be treated with estrogen modulators, such as clomiphene citrate. Women pursuing in vitro fertilization treatments should also be treated with metformin, to prevent ovarian hyperstimulation syndrome, which can lead to rapid weight gain, abdominal pain, and other undesirable side effects.
- Being wary of over-use of metformin, which in the past has been overprescribed for obesity, skin manifestations indicative of systemic diseases, or to prevent pregnancy complications.
The panel is also wary of using insulin sensitizers, such as inositols or thiazolidinediones, due to the link between insulin and PCOS. Many women with PCOS have elevated insulin levels, in addition to other hormone imbalance issues.
Women with PCOS should speak with a fertility specialist
If you have been diagnosed with PCOS and plan to have a baby, make an appointment with Reproductive Resource Center to speak with a fertility specialist as soon as possible. We can support you every step of the way and will work to increase your fertility chances so you can experience the joy of pregnancy and birth.