Hi Again, ( Please see the section on Hirsutism also)
Good day.
The main presenting symptoms in patients with poly cystic ovary syndrome (PCOS) are,
a) Irregular or absent menstural periods,
b) Weight gain ( or other symptoms becme obvious after weight gain)
c) Excessive hair growth on face, chest, abdomen, inside of arms, inner thighs etc,
c) Infertility,
d) Pimples ( acne ),
e) Hair fall in male like fashion ( Male pattern baldness, ie, hair fall from front and sides of scalp )
f) Darkening of skin behind neck, axilla, groin etc ( Acanthosis Nigricans)
However, many of these symptoms can occur in other diseases also, and hence they are non specefic. Obesity or excess weight is often seen in PCOS but it is not mandatory for the diagnosis.
During my fellowship days, i did reaserch on Metabolic syndrome in PCOS and we have seen many thin girls with PCOS. We have also seen excessive hair growth in girls with out PCOS ( other hormone diseases). Sometimes, they can even have regular periods, however, these periods often are anovulatory ( which means, ovulation may not be occuring despite having regular vaginal bleeding/periods)
Some people may have change in voice to a husky male like voice , body becoming more muscular, increase in libido and enlargement of clitoris etc if the male hormone levels are very high. Eventhough these are associated with PCOS, presence of these features usually point towards another hormonal disorder other than PCOS.
One point to remember is that, the symptoms of PCOS often start at the time of menarche ( first periods) itself. Late or recent onset of symptoms may not be due to PCOS and a number of other disorders ( Hypothyroidism, high prolactin levels, acromegaly, cushing's syndrome, congenital adrenal hyperplasia, insulin resistant states, ovary/adrenal tumours etc ) need to be considered as differential diagnosis. Ovarian hyperthecosis is a severe form of PCOS.
There is a strong relationship of polycystic ovary syndrome with high cholesterol, diabetes and infertility. Rarely it is also associated with endometrial cancer. Hence it is importnat to identify PCOS.
PCOS can run in families and there is a genetic component also. Many family members of the patient may have , diabetes, heart diseases, high cholesterol, high blood pressure etc.
Diagnosis of PCOS:
There are several diagnostic criteria. However there are controverises also. We use Rotterdam criteria to diagnose PCOS.
Chance of PCOS is likely, if a person has > 2 of the following,
a) Irregular periods
b) Symptoms/Signs of hyperandrogenism ( excess male hormone) or a lab test showing high male hormone levels.
c) Presence of ploycystic ovary on ultrasound scanning.
So, either a+b= PCOS, or a+c = PCOS, or b+c= PCOS.
This means that, all patients with PCOS may not have poly cystic appeaing ovaries in USG. ( This is not mandatory for the diagnosis)
One other thing to remember is that 15% of normal girls also can have poly cystic appearing ovaries on ultrasound. Also, patients with many other hormonal disorders can develop poly cystic appearing ovaries with out having PCOS.
This means that all those patients with poly cystic appearing ovaries on ultra sound need not have PCOS.
Hmm SOUNDS CONFUSING, well it is !! . But dont worry, diagnosis of PCOS is not difficult. The main challenge is to differentiate PCOS from other disorders that mimick PCOS.This is possible by examination and simple blood tests.
PCOS is a complex disorder and patient may approach various specialists. They may present to dermatologist ( skin specialist) with pimple, excess hair growth and dark skin behind neck. They may present to a Gynecologist or Endocrinologist with irregular periods. They may present to endocrinologist/Physician with elevated cholesterol, diabetes or obesity. Often a multi disciplinary approach is necessary which also include a dietitian.
Timing of doing these blood tests should be optimum. Otherwise the results can be confusing. Also, make sure that, the tests are done in a reputed laboratory with good hormone assays ( third generation hormone testing facility like CLIA).
A high quality timed ultrasound also is needed.
Apart from hormone tests like LH, your doctor also may test Thyroid function test, Prolactin levels, Cholesterol levels, blood glucose levels, 17 Hydroxy progesterone etc on a case to case basis. If the Ultrasound shows increase in endometrial thickness, occasionally an endometrial biospy also may be required.
we shall discuss about the complications and treatment later.
Regards
Dr.Binu P Pillai
Specialist Endocrinologist
Sugar-Apollo, International Medical Centre
MUSCAT, OMAN
http://sugarimc.com
Good day.
The main presenting symptoms in patients with poly cystic ovary syndrome (PCOS) are,
a) Irregular or absent menstural periods,
b) Weight gain ( or other symptoms becme obvious after weight gain)
c) Excessive hair growth on face, chest, abdomen, inside of arms, inner thighs etc,
c) Infertility,
d) Pimples ( acne ),
e) Hair fall in male like fashion ( Male pattern baldness, ie, hair fall from front and sides of scalp )
f) Darkening of skin behind neck, axilla, groin etc ( Acanthosis Nigricans)
However, many of these symptoms can occur in other diseases also, and hence they are non specefic. Obesity or excess weight is often seen in PCOS but it is not mandatory for the diagnosis.
During my fellowship days, i did reaserch on Metabolic syndrome in PCOS and we have seen many thin girls with PCOS. We have also seen excessive hair growth in girls with out PCOS ( other hormone diseases). Sometimes, they can even have regular periods, however, these periods often are anovulatory ( which means, ovulation may not be occuring despite having regular vaginal bleeding/periods)
Some people may have change in voice to a husky male like voice , body becoming more muscular, increase in libido and enlargement of clitoris etc if the male hormone levels are very high. Eventhough these are associated with PCOS, presence of these features usually point towards another hormonal disorder other than PCOS.
One point to remember is that, the symptoms of PCOS often start at the time of menarche ( first periods) itself. Late or recent onset of symptoms may not be due to PCOS and a number of other disorders ( Hypothyroidism, high prolactin levels, acromegaly, cushing's syndrome, congenital adrenal hyperplasia, insulin resistant states, ovary/adrenal tumours etc ) need to be considered as differential diagnosis. Ovarian hyperthecosis is a severe form of PCOS.
There is a strong relationship of polycystic ovary syndrome with high cholesterol, diabetes and infertility. Rarely it is also associated with endometrial cancer. Hence it is importnat to identify PCOS.
PCOS can run in families and there is a genetic component also. Many family members of the patient may have , diabetes, heart diseases, high cholesterol, high blood pressure etc.
Diagnosis of PCOS:
There are several diagnostic criteria. However there are controverises also. We use Rotterdam criteria to diagnose PCOS.
Chance of PCOS is likely, if a person has > 2 of the following,
a) Irregular periods
b) Symptoms/Signs of hyperandrogenism ( excess male hormone) or a lab test showing high male hormone levels.
c) Presence of ploycystic ovary on ultrasound scanning.
So, either a+b= PCOS, or a+c = PCOS, or b+c= PCOS.
This means that, all patients with PCOS may not have poly cystic appeaing ovaries in USG. ( This is not mandatory for the diagnosis)
One other thing to remember is that 15% of normal girls also can have poly cystic appearing ovaries on ultrasound. Also, patients with many other hormonal disorders can develop poly cystic appearing ovaries with out having PCOS.
This means that all those patients with poly cystic appearing ovaries on ultra sound need not have PCOS.
Hmm SOUNDS CONFUSING, well it is !! . But dont worry, diagnosis of PCOS is not difficult. The main challenge is to differentiate PCOS from other disorders that mimick PCOS.This is possible by examination and simple blood tests.
PCOS is a complex disorder and patient may approach various specialists. They may present to dermatologist ( skin specialist) with pimple, excess hair growth and dark skin behind neck. They may present to a Gynecologist or Endocrinologist with irregular periods. They may present to endocrinologist/Physician with elevated cholesterol, diabetes or obesity. Often a multi disciplinary approach is necessary which also include a dietitian.
Timing of doing these blood tests should be optimum. Otherwise the results can be confusing. Also, make sure that, the tests are done in a reputed laboratory with good hormone assays ( third generation hormone testing facility like CLIA).
A high quality timed ultrasound also is needed.
Apart from hormone tests like LH, your doctor also may test Thyroid function test, Prolactin levels, Cholesterol levels, blood glucose levels, 17 Hydroxy progesterone etc on a case to case basis. If the Ultrasound shows increase in endometrial thickness, occasionally an endometrial biospy also may be required.
we shall discuss about the complications and treatment later.
Regards
Dr.Binu P Pillai
Specialist Endocrinologist
Sugar-Apollo, International Medical Centre
MUSCAT, OMAN
http://sugarimc.com
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