Polycystic Ovary Syndrome: Symptoms and Diagnosis Insights

Q: Polycystic Ovary Syndrome: Symptoms and Diagnosis Insights

Q： Am I at a high risk for polycystic ovary syndrome? <br>A： This is a significant question. <br>Prepare the relevant information and visit a medical center to schedule an appointment with the obstetrics and gynecology department for infertility consultation.

Polycystic Ovary Syndrome (PCOS)

Hello Doctor, my parents have been urging me to see a metabolic specialist to check for any issues, as they believe I have gained too much weight.
I have been married for a year and seven months, and I gained about 8-10 kg within three months after marriage, with gradual increases thereafter.
Before marriage, I weighed around 65-68 kg, and now I weigh 78 kg at a height of 160 cm.
I have always thought it was a dietary issue; I used to eat out frequently but with less oil and salt, and I also cook at home with low oil and low salt.
My in-laws' diet is oilier but less salty.
Additionally, I feel that my metabolism has noticeably declined since I turned 25.
I consulted a metabolic specialist who arranged for blood tests to check my thyroid and metabolic issues, and the results were normal.
However, due to my puffy face, both doctors suspect I might have polycystic ovary syndrome (PCOS).

I found the following symptoms online, but I feel okay:
1.
Irregular or absent menstruation, poor ovulation → My periods are not irregular; they may occasionally be late by 1-2 weeks, but this is rare.
The last time I missed a period was in May and June, and prior to that, I had no such issues for over a year.
I have taken medication to induce menstruation twice.

2.
Ultrasound shows enlarged ovaries with many small follicles that do not easily mature, but not all patients show this change → A vaginal ultrasound indicated that my uterus and ovaries are healthy.
I have seen a gynecologist regularly over the past year, including in recent months, and have had vaginal ultrasounds each time.

3.
Elevated male hormones, leading to acne, excessive hair growth, or hair loss → I do get acne, especially when my period is absent, but it’s not excessive; I occasionally get 1-2 pimples.
I do have some hair loss, and my hair has thinned compared to before, but it is currently average in volume.
I have normal arm hair, facial hair, and leg hair, which seems a bit excessive for a woman.

4.
Infertility → I had a positive pregnancy test on June 18, 2016, with a blood level of 400 on May 22 (my period was from May 8-14).
I experienced some bleeding on June 22, resembling the start of a period, with slight blood streaks.
A follow-up test showed a decrease to 309, and the doctor said it was an incomplete embryo that had naturally aborted.
I was told this is common, with 7 out of 10 women experiencing this, but there is a higher chance of recurrence.
I passed the embryo from June 22 to June 26, and the bleeding stopped by July 4.
Does this count as infertility?
5.
Elevated insulin levels, insulin resistance, poor insulin utilization, or existing diabetes → I do not use insulin and have no diabetes.

6.
Obesity, typically with a waist-to-hip ratio indicating central obesity → My father’s side has a history of obesity; I have always been slightly overweight.
Four years ago, I lost weight from 68 kg to 60 kg, but after stopping exercise and starting a relationship, I gained it back.

7.
Hypertension → My blood pressure is normal.
I have been exercising, but weight loss is slow; I have only lost 2 kg since March.
I exercise about 2-3 days a week.
Since June, due to family matters, I have only been to the gym six times.
The doctor has arranged for additional tests, but because I took medication to induce menstruation in June, the doctor said it might affect the results.
Therefore, I have not had my period for the past two months and am scheduled for blood tests in October to check FSH, LH, and Testosterone levels.
However, October is still a long way off.

I would like to ask the doctor: Is the vaginal ultrasound for PCOS accurate? Is blood testing necessary for diagnosis? What is the likelihood that I have PCOS?

Shi's, 20~29 year old female. Ask Date: 2017/07/17

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Q: Am I at a high risk for polycystic ovary syndrome?
A: This is a significant question.
Prepare the relevant information and visit a medical center to schedule an appointment with the obstetrics and gynecology department for infertility consultation.

Reply Date: 2017/07/17

More Info

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. It is characterized by a combination of symptoms that can include irregular menstrual cycles, elevated levels of male hormones (androgens), and polycystic ovaries as seen on ultrasound. Understanding PCOS is crucial for diagnosis and management, especially given its potential long-term health implications, including infertility, metabolic syndrome, and increased risk of type 2 diabetes and cardiovascular disease.

Symptoms of PCOS
1. Irregular Menstrual Cycles: Women with PCOS often experience irregular or absent menstrual periods. This can manifest as infrequent periods or prolonged cycles, which may lead to challenges in conception.

2. Hyperandrogenism: This refers to elevated levels of male hormones in women, which can lead to symptoms such as acne, excessive hair growth (hirsutism), and thinning hair on the scalp (androgenic alopecia).
3. Polycystic Ovaries: On ultrasound, ovaries may appear enlarged and contain multiple small follicles (often referred to as "string of pearls"). However, not all women with polycystic ovaries will have PCOS, and vice versa.

4. Weight Gain: Many women with PCOS experience weight gain or have difficulty losing weight. This can be attributed to insulin resistance, which is common in PCOS.

5. Infertility: Due to irregular ovulation, women with PCOS may face challenges in conceiving.

6. Skin Changes: In addition to acne, women may experience dark patches of skin (acanthosis nigricans) and skin tags.

Diagnosis of PCOS
The diagnosis of PCOS is typically made based on the Rotterdam criteria, which require the presence of at least two of the following three features:
1. Irregular Ovulation: Documented irregular menstrual cycles or anovulation.

2. Hyperandrogenism: Clinical signs (e.g., hirsutism, acne) or biochemical evidence (elevated testosterone levels).

3. Polycystic Ovaries: Ultrasound findings showing multiple small follicles in the ovaries.

It is important to note that a diagnosis of PCOS does not rely solely on one test or symptom. A comprehensive evaluation, including a detailed medical history, physical examination, and laboratory tests (like hormone levels), is essential.

Laboratory Tests
Blood tests are often conducted to measure hormone levels, including:
- FSH (Follicle Stimulating Hormone): Typically low in PCOS.

- LH (Luteinizing Hormone): Often elevated in PCOS.

- Testosterone: Elevated levels can indicate hyperandrogenism.

- Insulin Levels: To assess for insulin resistance.

Importance of Ultrasound
Transvaginal ultrasound is a valuable tool in diagnosing PCOS, as it can visualize the ovaries and help identify the presence of multiple follicles. However, it is not definitive on its own. The combination of ultrasound findings with clinical symptoms and laboratory results provides a more accurate diagnosis.

Management of PCOS
Management strategies for PCOS focus on symptom relief and addressing associated health risks. These may include:
- Lifestyle Modifications: Weight loss through diet and exercise can significantly improve symptoms and insulin sensitivity.

- Medications: Hormonal contraceptives can help regulate menstrual cycles and reduce hyperandrogenic symptoms. Metformin may be prescribed to improve insulin sensitivity.

- Fertility Treatments: If conception is a goal, medications such as clomiphene citrate or letrozole may be used to induce ovulation.

Conclusion
Given your concerns about potential PCOS, it is essential to follow up with your healthcare provider for further evaluation. The combination of your symptoms, ultrasound findings, and hormone levels will help determine if you have PCOS. Early diagnosis and management can help mitigate long-term health risks associated with the syndrome. Remember, PCOS is a manageable condition, and many women with PCOS lead healthy, fulfilling lives with appropriate care and lifestyle adjustments.

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