Part I: Understanding PCOS and getting a diagnosis
By Mary Sabo, L.Ac DACM
Polycystic Ovarian Syndrome or PCOS is the most common endocrine disorder among women of reproductive age. With the wide spread use of birth control pills, which externally regulate the menstrual cycle, PCOS is becoming more and more common. A lot of my patients get concerned that the pill may have caused their PCOS, but this doesn’t seem to be the case. It is more likely that the pill just masks the dysfunction that is occurring over time. It is not fully understood why so many women are being diagnosed with PCOS, but diet and genetic factors are likely part of it. Since PCOS can present in many different ways, let’s take a closer look at this ovarian disorder.
PCOS is associated with an increased number or congestion of follicles in the ovary that can lead to some or all of the following:
- anovolution (absence of ovulation)
- increased levels of androgen hormones like testosterone or DHEA
- long cycles
- amenorrhea (absence of a period)
- thinning hair on their head and increased body hair growth in places such as around the nipples, on the chest or abdomen, and on the face
- digestive problems
- insulin resistance
Occasionally, the only sign or symptom is irregular periods or anovulation (which may or may not be obvious as some women continue having regular periods) and the diagnosis is made just through transvaginal ultrasound. This is referred to as simply polycystic ovaries (PCO) without the “syndrome” involving elevated testosterone levels and insulin resistance. Some women don't realize they have PCO or PCOS because they still get periods and some may even ovulate some or all cycles. Women on hormonal birth control typically have no symptoms and it is not until they discontinue use that they begin noticing symptoms or simply do not get periods.
The diagnosis of PCOS is made through a blood test looking for increased testosterone and DHEA levels along with a transvaginal ultrasound to look at the number of follicles in the ovary. Some doctors may also measure hemoglobin A1C or insulin and blood glucose levels, all of which can reflect the presence of insulin resistance. Blood tests may also reveal elevated Luteinizing Hormone (LH) and lowered Follicle Stimulating Hormone (FSH) from the pituitary gland and high Antimüllerian Hormone (AMH). Some of the Reproductive Endocrinologists I frequently share patients with consider an ovary containing more than 15 visible antral follicles on an ultrasound polycystic, even in cases where androgens are not elevated, but symptoms are present.
If you have a diagnosis of PCOS or PCO or suspect you might be at risk, there are lots of options to help you! See PCOS PART II of this blog for treatment options and tips on naturally supporting your ovarian function. If you are in the NYC area and need support for your hormone health or fertility, contact us or schedule a session online and we will work with you to form a customized plan to help you manage your symptoms and meet your goals.