As part of PCOS Awareness Month 2021, over the next two articles we’ll explore how PCOS is diagnosed, and how to manage and treat the symptoms of this chronic condition. Please see our previous articles for information about fertility and mental health. Today we will cover the diagnosis of PCOS including the symptoms, before exploring treatment options for a common symptom – irregularities with the menstrual cycle.
Diagnosing PCOS
No test will definitively diagnose PCOS on its own, so doctors use a combination of tests to form a diagnosis. A doctor is likely to start with a discussion of your medical history, including asking you about your menstrual periods and weight changes. A physical examination will include checking for signs of high testosterone levels such as excess hair growth and acne.
Your doctor might also recommend a pelvic exam to check for masses or any other abnormalities. Blood tests will also be analysed to measure hormone levels, glucose tolerance, or fasting cholesterol and triglyceride levels. A transvaginal ultrasound will help you doctor check the appearance of your ovaries and the thickness of the uterus lining.
A diagnosis of PCOS involves a combination of the following:
- irregular periods
- clinical or biochemical evidence of excess testosterone
- polycystic morphology on ultrasound scan.
If you are diagnosed with PCOS, your doctor might also recommend some additional tests including:
- Ongoing checks of blood pressure, glucose tolerance, and cholesterol and triglyceride levels
- Screening for anxiety and depression
- Screening for obstructive sleep apnoea.
Symptoms of PCOS
Women who have PCOS may experience some of the following:
- Irregular menstrual cycles.
- Amenorrhoea – no periods
- Excessive facial or body hair growth
- Scalp hair loss
- Acne
- Reduced fertility
- Mood changes including anxiety and depression
- Obesity
Managing and treating the symptoms of PCOS
PCOS cannot be cured, but it can be managed. Treatments for PCOS focus on managing a woman’s individual concerns – which might include infertility, acne or obesity. Depending on the concern, specific treatment might involve lifestyle changes, medication and/or psychological counselling.
PCOS is best managed using a multi-disciplinary approach. This is because PCOS can have many symptoms, so a range of treatments might be necessary to help manage the condition.
Eating well, preventing excessive weight gain and being physically active are the first steps and the best ways to improve symptoms and manage your long-term health. It is also important to minimise harmful habits like smoking and excessive drinking.
Managing an irregular menstrual cycle
Having regular periods helps keep the uterus healthy and avoids abnormal cells building up inside the womb. The average menstrual cycle is 28 days – but anywhere between 21 and 35 days is considered normal.
Ways to manage irregular periods include a healthy diet and exercise, weight loss if you are overweight and/or:
- Hormonal contraception such as the pill, mini-pill, Implanon or Mirena. Regulating your hormones can help lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Pill alternatives include skin patches or vaginal rings that contain a combination of estrogen and progestin.
- Insulin-sensitising medications can be used for treating women with PCOS who don’t ovulate. These medications can help people with insulin resistance, or to improve ovulation and fertility. It may assist with diabetes and slow down/prevent the onset of diabetes.
There are possible side effects with hormonal contraceptive medication such as mood changes, weight gain or loss, bloating, breast tenderness and irregular bleeding. Side effects differ depending on the type of pill or device. Ask you doctor about all the risks and benefits.
Medications to help with ovulation that your doctor might recommend include:
- Clomiphene (Clomid). An oral anti-estrogen receptor medication leading to increased production of gonadotropins for follicle development
- Letrozole (Femara): Reduces serum estrogen levels leading to stimulation of ovaries. Also used as part of breast cancer treatment.
- Metformin (Glucophage, Fortamet & others). An oral medication to improve insulin resistance and lower insulin levels for type 2 diabetes.
- Hormone medications given by injection for follicular growth..
Look out for next week’s blog for more information on other symptoms of PCOS and treatments.
Sources and further reading:
- Jean Hailes for Women’s Health
- Jean Hailes for Women’s Health (fact sheet)
- Jean Hailes for Women’s Health (healthy food & exercise)
- Better Health Channel
- Mayo Clinic
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