What Is PCOS and How Do We Diagnose It?

Polycystic Ovarian Syndrome is a tricky diagnosis to get. It often takes two years and up to three doctors to figure out what all your symptoms mean. But, it’s also one of the most common causes of female infertility, affecting 6% to 12% (as many as 5 million) of U.S. women of reproductive age. Outside of getting pregnant, PCOS can negatively affect a woman’s life and make her feel emotionally and physically imbalanced by the repeated shift in hormones.

All of that is why it’s time to demystify it—so you can be an advocate for yourself, ask the questions you need, and get the answers you deserve. Let’s dive deeper into what the syndrome is and how we diagnose it (plus symptoms you can look out for).

What Is PCOS and What Are Its Symptoms?

Polycystic Ovarian Syndrome can be hard to diagnose because it shows up in a few ways that can often be confused with other conditions—or just really painful periods, which we’ve talked about before as not being entirely normal. But what does having PCOS mean?

It starts with infrequent periods, meaning that your cycle lengths get inconsistent. You might not be ovulating, or your ovulation could be spotty. Without ovulation, your periods can be really erratic. Some typical patterns we see are:

  1. Having a bleed once every 3 months that lasts either 1-3 days or 9-14 days. 
  2. Having a bleed every 6 weeks for 1 week or longer. 
  3. Having a bleed every couple of weeks for 2 months or longer, then it disappears for several months. 
  4. Not having a bleed at all.

Tests will also reveal high androgens, or DHEA, testosterone, and dihydrotestosterone. Coarse, dark hair growth on the upper lip, sideburns, chin and arms is the result, as is deep, painful cystic acne on your face, shoulders, chest, and back (more on that here).

And the biggie: Cysts begin to form on your ovaries. These cysts come from eggs that attempted to ovulate, but couldn’t, forming the often very painful cysts. You might notice one-sided pain (since you usually release one egg each month, and your ovaries alternate months) when a cyst is being created. You could have multiple cysts, which can be seen with an ultrasound of your pelvis and ovaries.

How We Diagnose PCOS

Because PCOS is a spectrum disorder, not every woman with PCOS looks exactly the same. You only need two of the following three criteria to meet a diagnosis of PCOS, but depending on multiple factors (diet, exercise frequency, birth control usage, and more), the severity of your symptoms may be different than another person with the same diagnosis. 

  1. Hyperandrogenism: The presence of excessive acne, androgenic alopecia, or hirsutism (terminal hair in a male-pattern distribution); or by elevated serum levels of total, bioavailable, or free testosterone or dehydroepiandrosterone sulfate.
  2. Ovulatory dysfunction: Oligomenorrhea (cycles more than 35 days apart but less than six months apart) or amenorrhea (absence of menstruation for six to 12 months after a cyclic pattern has been established).
  3. Polycystic ovaries: An ovary containing 12 or more follicles (or 25 or more follicles using new ultrasound technology) measuring 2 to 9 mm in diameter or an ovary that has a volume of greater than 10 mL on ultrasonography.

Women with PCOS also often suffer from metabolic issues including insulin resistance, weight gain, and difficulty controlling blood sugars. When you couple hormonal issues with metabolic issues, PCOS can affect your future fertility, and is often diagnosed when you’re having difficulty with conceiving.

But that doesn’t mean it’s not something to consider getting checked out now, if you’re having any of the above symptoms. Consider speaking to one of our clinicians, all of whom have extensive experience with hormonal imbalance and diagnostics. Think this might be the route for you? Book an online appointment to discuss your potential for PCOS.