To diagnose PCOS or Polycystic Ovarian Syndrome properly, a woman must undergo comprehensive testing. This condition varies dramatically in its presentation. If severe, there is an excess of ovarian androgens (male hormones), lack of ovulation (anovulation), and polycystic ovaries. 

 PCOS affects 5% to 10% of females, making it a leading cause of infertility in women of childbearing age.[1,2] However, it does not translate into an ‘infertility sentence.’ 

 With diligent self-care and lifestyle interventions, you can manage your PCOS successfully. But even so, strategic management can only begin if you have been diagnosed with PCOS in the first place. 

 So in this article, we will discuss the test components of a proper diagnosis and the signs, symptoms, and causes of PCOS. In addition, we will share further insights into its health implications in the long run when left neglected.

Signs and Symptoms of PCOS

The official medical diagnosis of PCOS (or criteria) requires at least two of the following features to be present [21] :

  • Multiple ovarian follicles arranged in a pearl necklace shape around the ovaries[1,2]

  • Oligo-ovulation (irregular ovulation) or Anovulation (lack of ovulation)

  • Clinical or biochemical evidence of androgen excess.[3]

Clinically, we observe a vast number of signs and symptoms of PCOS that can vary from woman to woman, including the following:

  • Hormonal imbalances that may include:

    • Raised testosterone levels

    • Increased conversion of testosterone to dihydrotestosterone (DHT)

    • Lower than normal estradiol or estrogen dominance

    • Reduced sex hormone binding globulin (SHBG) levels

    • Raised anti-mullerian hormone (AMH) levels for age

    • Luteinizing hormone (LH) dominance
      (Follicle-stimulating hormone or FSH: LH > 1:2)  

  • Hirsutism (excessive or male-pattern hair growth)

  • Acne and pimples and excessively oily skin or hair

  • Difficulty losing weight and/or obesity

  • Longer than typical menstrual cycles (>32 days) due to ovulation occurring later than day 14.

  • Anovulation (lack of ovulation)

  • Insulin resistance and blood sugar imbalances that cause symptoms of hypoglycemia 

  • Metabolic syndrome, cardiovascular risks, and hyperlipidemia 

  • Hypothyroidism

It is essential to note that the PCOS symptoms checklist above is only a guide to some women’s experiences and our clinical observations. Not all females have the same presentation of symptoms. 

For example, many women diagnosed with PCOS are slim and have no excessive hair growth, pimples, or even cysts in their ovaries.[4] Hence a medical practitioner can often dismiss PCOS if they only look for 2 out of 3 of the medically recognized symptoms. As a result, an estimated 70% of women with PCOS are undiagnosed at any given time.[5]

What Causes PCOS?

There is insufficient general agreement in the literature about the causes of PCOS. However, it is suggested that the condition runs in families and ethnic groups (although a specific genetic link remains to be established).


In addition, environmental triggers are proposed to play a role in developing PCOS[6] : 

 

  • Contraceptive pill

  • Sugar

  • High carbohydrate intake

  • Weight gain

  • Certain nutritional deficiencies.

Fortunately, PCOS prevention is possible by utilizing holistic health management, which is also an essential part of the treatment process.[7,8]

Diagnosing PCOS

  • The best way to attain a proper diagnosis is to see a healthcare professional and request blood tests, a pelvic ultrasound, and a revision of your presenting symptoms.

A blood sample collected before 10 am after an overnight fast, preferably performed on day 2 or 3 of your cycle if you are menstruating semi-regularly, would be ideal.

Here are the PCOS diagnosis guidelines or the comprehensive blood work-up list to diagnose PCOS and possible related irregularities:[9-13]

  • Follicle-stimulating hormone (FSH)

  • Luteinizing hormone (LH)

  • Oestradiol (E2) 

  • Anti-Müllerian hormone (AMH)

  • Thyroid-stimulating hormone (TSH)

  • Dehydroepiandrosterone (DHEA)

  • Total and free testosterone

  • Prolactin

  • Sex hormone binding globulin (SHBG)

  • Fasting glucose

  • Fasting insulin

  • Fasting blood lipids, including triglycerides and high and low-density lipoprotein (HDL/LDL) cholesterol

  • Fasting homocysteine

What Is Expected to Be Found?

The likely findings in women with PCOS (individuals can vary significantly) include[14,15]:

  • Increased LH: FSH ratio of at least 2:1 (key diagnostic finding in many women)

  • Usually, elevated total and free testosterone

  • Generally lowered SHBG.

In some women, results show simultaneously lowered estradiol levels with increased insulin and glucose levels. Moreover, there is an increase in homocysteine, cholesterol levels, and triglycerides for some.[16,17]

But remember that even though some women may not obtain all of the above findings, they may still be diagnosed with PCOS if they have multiple follicles in the ovaries, anovulation or menstrual irregularities, hirsutism, and acne.

Long-Term Health Effects of PCOS

Women with PCOS are more prone to developing insulin resistance, diabetes, cardiovascular disease, and metabolic syndrome later in life if the condition is not managed correctly.[18-20]

Final Thoughts

Now that you have learned how to diagnose PCOS, we want to emphasize that its symptoms are not precisely ‘curable’ — but relatively manageable.
 

A natural, holistic treatment approach yields effective results in helping women regulate cycles, lose weight, balance insulin and blood sugar levels, decrease male-pattern hair growth, treat acne, and boost natural fertility. Consequently, all of this help increase your chances of creating the healthiest possible baby.[21]

For some with milder cases of PCOS, symptoms seem to disappear entirely after a period of treatment. But the most effective treatment for the best long-term results involves permanent lifestyle changes supporting optimum general health.

Watch Ask Gabriela Rosa Live: Effective PCOS Solutions Examined for more practical tips and expert recommendations on managing PCOS and achieving your fertility goals.

If you are looking for PCOS diet plans, we have our growing range of fertility diet plans which are gluten-free, sugar-free, and dairy-free. They are a great starting point in managing the dietary elements of PCOS. Check them out by clicking here.

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References:

 

[1] Bozdag, G., et al. The Prevalence and Phenotypic Features of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Human Reproduction, 2016. 31(12). PMID: 27664216.

[2] Rausch, M.E., et al. Predictors of Pregnancy in Women with Polycystic Ovary Syndrome. Journal of Clinical Endocrinology and Metabolism, 2009. 94(9). PMID: 19509098.

[3] Goodman, N.F., et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome – Part 1. Endocrine Practice, 2015. 21(11). PMID: 26509855.

[4] Boyle J, Teede H. Polycystic ovary syndrome. Aust J Gen Pract. 2012;41:752-756.

[5] Teede, H., et al. Polycystic Ovary Syndrome: A Complex Condition With Psychological, Reproductive and Metabolic Manifestations That Impacts on Health Across the Lifespan. BMC Medicine, 2010. PMID: 20591140.
[6] Witchel, S.F., et al. Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. Journal of Endocrine Society, 2019. 3(8). PMID: 31384717.

[7] Lim, S.S., et al. Lifestyle Changes in Women With Polycystic Ovary Syndrome. Cochrane Database of Systematic Reviews, 2019. 3(3). PMID: 30921477.
[8] Sanchez-Garrido, M.A., et al. Metabolic Dysfunction in Polycystic Ovary Syndrome: Pathogenic Role of Androgen Excess and Potential Therapeutic Strategies. Molecular Metabolism, 2020. PMID: 32244180.

[9] Mohammad, M.B., et al. Polycystic Ovary Syndrome (PCOS), Diagnostic Criteria, and AMH. Asian Pacific Journal of Cancer Prevention, 2017. 18(1). PMID: 28240001.
[10] Legro, R.S. Evaluation and Treatment of Polycystic Ovary Syndrome. Endotex, 2017. PMID: 25905194.
[11] Ding, X., et al. Subclinical Hypothyroidism in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology, 2018. PMID: 30542323.
[12] Maleedhu, P., et al. Status of Homocysteine in Polycystic Ovary Syndrome (PCOS). Journal of Clinical and Diagnostic Research, 2014. 8(2). PMID: 24701474.
[13] Behboudi-Gandevani, S., et al. Insulin Resistance in Obesity and Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis of Observational Studies. Gynecological Endocrinology, 2016. 32(5). PMID: 27052492.
[14] Malin, N.A., et al. Evaluation of Different Ranges of LH: FSH Ratios in Polycystic Ovarian Syndrome (PCOS) – Clinical Based Case-Control Study. General and Comparative Endocrinology, 2018. PMID: 29273352.
[15] Deswal, R., et al. Sex Hormone Binding Globulin – An Important Biomarker for Predicting PCOS Risk: A Systematic Review and Meta-Analysis. Systems Biology in Reproductive Medicine, 2018. 64(1). PMID: 29227165.
[16] Krishnan, A., et al. Hormonal Alterations in PCOS and Its Influence on Bone Metabolism. Journal of Endocrinology, 2017. 232(2). PMID: 27895088.
[17] Yilmaz, M., et al. Levels of Lipoprotein and Homocysteine in Non-Obese and Obese Patients With Polycystic Ovary Syndrome. Gynecological Endocrinology, 2005. 20(5).  PMID: 16019370.
[18] Amiri, M., et al. Risk of Hypertension in Women With Polycystic Ovary Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression. Reproductive Biology & Endocrinology, 2020. 18(1). PMID: 32183820.
[19] Mani, H., et al.  Diabetes and Cardiovascular Events in Women With Polycystic Ovary Syndrome: A 20-year Retrospective Cohort Study. Clinical Endocrinology, 2013. 78(6). PMID: 23046078.
[20] Lim, S.S., et al. Metabolic Syndrome in Polycystic Ovary Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression. Obesity Reviews, 2019. 20(2). PMID: 30339316.
[21] Arentz, S., et al. Combined Lifestyle and Herbal Medicine in Overweight Women With Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial. Phytotherapy Research, 2017. 31(9). PMID: 28685911.