PCOS is a genetic condition of women, characterized by irregular periods, excess body hair, excess facial hair, acne, and obesity. Some of the features may be missing. Some women genetically likely to get PCOS might prevent it by avoiding obesity. Women with PCOS are at greater risk of developing Diabetes, heart disease, infertility, Sleep Apnea, Fatty Liver Disease, and Endometrial Cancer (of the uterus). Those who do become pregnant have more complications, especially miscarriages.
Diagnosis is made by finding the above signs and symptoms. About half of women with PCOS have abnormally high testosterone levels. Note that testosterone blood tests are most accurate when performed early in the morning. Interestingly, finding many cysts on ovaries by ultrasound has almost nothing to do with the disease, despite the name.
In a women with the above typical symptoms which suggest too much male hormone (even if a testosterone blood test is normal), diagnosis is aimed at ruling out other diseases. Tests may be ordered for:
1. Ultrasound of pelvis and abdomen for tumors of ovaries or adrenal glands
2. A variety of hormone tests to rule out uncommon diseases:
- “DHEAS” & 17-hydroxyprogesterone for adrenal gland diseases or tumors
- Cortisol for Cushing’s disease
- TSH for Thyroid Disease
- Prolactin for certain tumors of brain or pituitary gland
- Insulin-Like Growth Factor for pituitary gland tumors
If all these tests are normal, which they almost always are, we diagnose PCOS. Treatment depends on the symptoms or risks that we aim to control. Weight loss is a major treatment, especially for women trying to become pregnant (bariatric surgery can be successful here). Birth control pills and other hormones are used to regulate periods, & prevent endometrial cancer (women with very few periods are at greater risk, especially once they get older).