“information and facts”
” The Rotterdam criteria are commonly used to diagnose PCOS. According to the criteria, you need to have at least 2 of the 3 following symptoms:
- Irregular menstrual cycle
- Signs of hyperandrogenism (high testosterone) like acne, hair growth or hair loss
- Multiple follicles on your ovaries (seen on ultrasound)
Many doctors will do an ultrasound to check for multiple ovarian follicles as well as blood tests to check for high testosterone levels (amongst other hormone profiles).
Okay, so now that we know how PCOS is diagnosed, here are 8 reasons your PCOS diagnosis might be missed.
1. You are not overweight
There are many women who have lean PCOS. Their weight is normal (they may even be under weight). But, remember that although weight issues are often seen in women with PCOS, it’s not always the case and is not a diagnostic criteria for PCOS. Now, I have heard from women whose doctors did not pursue PCOS because they were not overweight.
2. You have a regular cycle
I have not always had a regular menstrual cycle. I’m very pleased to say that I do now. Does that mean that I don’t have PCOS anymore? Of course not. You only need 2 of the 3 criteria. So, you may well have a period regularly but struggle with high testosterone levels and ovarian follicles.
3. You did not have trouble getting pregnant
This is one that I have also come across frequently. A lot of women have gotten pregnant in spite of PCOS. Especially if you have a regular cycle.
A diagnosis of PCOS doesn’t always mean fertility difficulties, even though this is very common.
4. You don’t have a string of pearls.
I’m not talking about the pearls that you’d pay a small fortune to have. I’m talking about the string of pearls on your ovaries. You don’t need to have those ovarian follicles to have PCOS. 2 out of 3, remember?
5. Nobody else in your family has it
Although there is thought to be a strong genetic component to PCOS, it is not always seen in other female members of the family. For example, no other women in my family have PCOS, as far as I know.
6. You don’t have unwanted hair or acne
I know you’re starting to see a pattern here. Even if you don’t have hirsutism or acne, you could still have PCOS. If your cycle is irregular and you have the string of pearls, you could have PCOS.
7. You’ve been on birth control for years
A lot of us have been on the birth control pill for many many years. I was on it for at least 10 years before I was diagnosed with PCOS. The hormones from the pill often mask the symptoms of PCOS. It is only when you stop the pill that your symptoms come to light and you might start investigating the cause.
8. You’ve seen loads of doctors and none of them picked it up
Unfortunately this is another very common thing. It happened to me. PCOS is becoming more widely spoken about but there is still lack of awareness about PCOS. You may well have seen a number of doctors before you were diagnosed with PCOS.
So, there you have it. Your 8 reasons that your PCOS diagnosis may have been missed.”
Polycystic ovary syndrome causes irregular menstrual cycles, excessive body or facial hair and polycystic ovaries as its main symptoms. Polycystic means “many cysts,” and PCOS often causes clusters of small, pearl-sized cysts in the ovaries. The cysts are fluid-filled and contain immature eggs. Women with PCOS produce slightly higher amounts of male hormones known as androgens, which contribute to some of the symptoms of the condition. The cause of PCOS is not known. Some women with PCOS are less sensitive to insulin than other women, a condition known as insulin resistance. Insulin resistance can causes the ovaries to produce too many male hormones. The resulting hormonal imbalance can cause the symptoms of PCOS. The condition appears to run in families, and sisters of those with it are twice as likely to have it. Currently, PCOS has no cure, but a variety of PCOS treatments can help alleviate the symptoms of this disease, including infertility.
PCOS is a syndrome disease defined by a collection of signs and symptoms. The symptoms of PCOS that one patient experiences can be very different from the symptoms of another patient. If you have two or more of the following symptoms, you need to have a thorough checkup to determine if you need PCOS treatment:
- Irregular or missing menstrual periods
- Excess or unwanted body or facial hair growth
- Thinning hair on the scalp
- Weight problems, often including weight gain around the waist
- Skin problems, including skin tags, darkening skin and acne
Complications of PCOS
The common PCOS symptoms are difficult enough for most women, but some will experience further complications, including:
- Diabetes, elevated insulin levels or insulin resistance
- Heart and blood vessel problems
- Uterine cancer
- Sleep apnea
Each of these problems can be life threatening, which is why treatment for PCOS is so important.
Polycystic ovary syndrome treatment starts with a proper diagnosis. Treatments are then chosen based on a woman’s symptoms, age and future pregnancy plans. Treatment for PCOS may include:
- Birth control pills to regulate menstruation
- Insulin-sensitizing medications
- Ovulation induction to treat infertility
- Androgen-blocking medications
- Topical anti-hair-growth medications
- Other excess hair treatments
- Treatments for hair loss
- Acne treatments
- Removal of other skin problems
Lifestyle and Prevention
One of the best treatments for PCOS is a healthy lifestyle. A healthy diet low in refined carbohydrates is important, as this can help regulate blood sugar levels. Exercise can also help the body regulate insulin and keep excess weight off. Losing weight is challenging with PCOS, but doing so can help reduce the male hormone levels in the body, and some women will begin to ovulate naturally. With a proper diagnosis, lifestyle changes and PCOS treatment, women can get relief from this condition and the overwhelming health problems it can cause. .”
By Editors: Cristina Meriggiola, MD, PhD University of Bologna Musa Zamah, MD, PhD University of California, San Francisco
“What exactly is PCOS and how does it cause hirsutism in our clients? PCOS is one of the most common endocrine disorders facing women today, affecting as many as five million
women in the U.S. It affects up to 10 percent of women of reproductive age (12 to 45 years) although it can be found in girls as young as seven or eight and women well past menopause.
This disorder is thought to be the leading cause of diminished capacity for fertility in women. Although PCOS is one of the leading causes of infertility, the reproductive aspects of the disorder are secondary as PCOS is not limited to women of reproductive age and may not improve after menopause.
PCOS is known as polycystic ovarian syndrome. Common symptoms of PCOS may include irregular or no menstrual periods for women of reproductive age; irregular ovulation with or without bleeding; severe acne including cystic acne; thinning scalp hair; excessive hair growth on face and body (hirsutism); build up of follicles on the edges of the ovaries, these are often mislabeled as “cysts” and called “polycystic ovaries.”
It is not necessary to have all of these symptoms to have PCOS and in fact, it is not necessary to have the “polycystic ovaries” to have PCOS.
Weight management issues are found in over 60 percent of those suffering from PCOS. This can lead to obesity even with normal caloric intake due to the glucose which is stored as fat instead of being used as energy, or being made available for other functions within the body. This can lead to chronic fatigue and under nourishment. It is important to note that 40 percent of women with PCOS exhibit normal weight and may even fall under the normal weight range. Insulin resistance and diabetes are also exhibited in those with PCOS. More than 50 percent of women with PCOS will have diabetes or impaired glucose tolerance(pre-diabetes) before the age of 40.
Acanthosis nigricans may also be present. This is the medical term for darkened, velvety skin on the nape of the neck, armpits, inner thighs, vulva, or under breasts. This skin condition is a sign of insulin resistance.
The risk of heart attack is almost seven times higher in women with PCOS than those without this condition. These women also have a greater risk of high blood pressure, stroke, higher LDL(bad) cholesterol and low levels of HDL(good) cholesterol, and often develop sleep apnea, when breathing stops for short moments during sleep. PCOS sufferers may also develop anxiety and depression.
Women with PCOS may also be a risk for endometrial cancer. Estrogen is produced, but progesterone is not due to the irregular menstrual cycles and lack of ovulation. Without progesterone the lining of the womb, called endometrium, will become thick and will not shed during the menstrual period. Over time this can cause heavy or irregular bleeding and can lead to a condition where the lining grows too much and may cause cancer.
More than 75 percent of clients with PCOS have some level of hirsutism. This is an over production of the hormone, androgen. Hirsutism can be caused by an increased level of androgens or an oversensitivity of hair follicles to androgens. New studies implicate high circulating levels of insulin in women that contribute to the development of hirsutism. It is speculated that innsulin, at high enough concetration, stimulates the ovarian cells to produce androgens.
While the actual cause of PCOS is unknown, these factors likely play a role: Insulin is the hormone produced in the pancreas that allows cells to use sugar(glucose), it is the body’s primary energy supply. If the body has insulin resistance, the ability to use insulin effectively is impaired, and the pancreas has to secrete more insulin to make glucose available to cells. The excess insulin is thought to boost androgen production by the ovaries.
Heredity may also play a role in PCOS. If a female family member has PCOS, the client might have a greater chance of having it, too.
There is no specific test to definitely diagnose polycystic ovary syndrome. The diagnosis is one of exclusion. A medical history and physical exam will take menstrual cycles, weight, blood pressure, and various symptoms into consideration. A pelvic examination and ultrasound will inspect reproductive organs for signs of masses, growths, or other inconsistent abnormalities. Blood test will also be performed to measure hormones, cholesterol, and tryglyceride level.
Treatment of PCOS is usually centered on specific concerns. The physician might suggest regulating menstrual cycles through prescription medications. As professional electrologists we work with the PCOS clients to assist in removal of the excess hair associated with hirsutism. In addition to prescription medications, clients with PCOS might investigate more holistic or natural forms of care such as a diet rich with complex carbohydrates such as whole grains, brown rice, and beans; increased exercise program and supplements like alpha lipoic acids, B12 and B6, folic acid, vitamin D, magnesium, and cinnamon root.
Treatment of symptoms can often mask the underlying issues which can lead to more serious conditions, like diabetes and endometrial cancer, so a team approach to care includes a primary physician or ob/gyn, endocrinologist, dermatologist, nutritionist, physical trainer and electrologist!
Helping our clients deal with the hirsutism or acne associated with PCOS will alleviate some of the stress that goes along with this condition. Understanding the underlying causes and symptoms may allow you to help a client struggling with undiagnosed PCOS to seek a physician’s care and perhaps discover the answer to a long time health concern.”
by Nadine Toriello, The Society for Clinical & Medical Hair Removal, Inc