Polycystic Ovary Syndrome: Diagnosis and Treatment Options

Polycystic Ovary Syndrome (PCOS)

Hello, my menstrual cycle has been regular every month, originally on a 28-day cycle.
However, in the past six months, the cycle has changed to 28-32 days, and the menstrual flow has gradually decreased from a consistent 7 days to between 3-7 days.
Recently, I felt unwell and had an ultrasound, where the doctor mentioned I might have polycystic ovary syndrome (PCOS) and advised me to take menstrual regulation medication every month.
I was quite anxious, so I went to another doctor for a second ultrasound, and he told me that the ultrasound findings are not definitive and that I should have a blood test for confirmation.
My period is expected to start in a few days.
Should I have the blood test first, or is it better to start taking the menstrual regulation medication? Does the ultrasound result alone confirm the presence of polycystic ovaries?

Niu, 20~29 year old female. Ask Date: 2016/03/17

Dr. Cao Guotao reply Obstetrics and Gynecology

The diagnosis of polycystic ovary syndrome (PCOS) is not based on a single criterion.
Generally, patients may present with obesity, hirsutism, and irregular menstrual cycles.
A comprehensive diagnosis is made by combining these clinical findings with ultrasound and blood tests.
If there are still symptoms present, it may be advisable to visit a hospital for further evaluation by an obstetrician-gynecologist and additional blood tests.
Wishing you good health.

Reply Date: 2016/03/17

More Info

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. It is characterized by a combination of symptoms, including irregular menstrual cycles, excess androgen levels, and polycystic ovaries as seen on ultrasound. Understanding the diagnosis and treatment options for PCOS is crucial for managing the condition effectively.

Based on your description, it seems you have experienced changes in your menstrual cycle, which can be a sign of hormonal imbalance often associated with PCOS. The fact that your cycles have become irregular, with variations in length and a decrease in menstrual flow, is noteworthy. Additionally, the ultrasound findings of "somewhat polycystic ovaries" suggest that there may be multiple small cysts present on your ovaries, which is a common feature 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 or absent menstrual cycles (oligomenorrhea or amenorrhea).

2. Clinical or biochemical signs of hyperandrogenism (such as excess hair growth, acne, or elevated testosterone levels).

3. Polycystic ovaries visible on ultrasound.

In your case, the irregular menstrual cycles and ultrasound findings suggest that you may meet the criteria for PCOS, but a definitive diagnosis often requires blood tests to check hormone levels, including androgens and insulin.
Regarding your question about whether to have blood tests done first or to start taking medication for regulating your menstrual cycle, it is generally advisable to have the blood tests performed before starting any treatment. This is because the results can provide valuable information about your hormone levels and help guide the most appropriate treatment plan.
If your blood tests confirm elevated androgen levels or other hormonal imbalances, your doctor may recommend specific treatments. Common treatment options for managing PCOS include:
1. Lifestyle Modifications: Weight loss through diet and exercise can significantly improve symptoms and regulate menstrual cycles, especially in overweight individuals.

2. Hormonal Birth Control: Oral contraceptives can help regulate menstrual cycles, reduce androgen levels, and improve symptoms such as acne and excessive hair growth.

3. Metformin: This medication is often used to treat insulin resistance, which is common in women with PCOS. It can help regulate menstrual cycles and promote ovulation.

4. Ovulation Induction: If you are trying to conceive, medications such as Clomiphene citrate or Letrozole may be prescribed to stimulate ovulation.

5. Anti-androgens: Medications like spironolactone can help reduce symptoms of hyperandrogenism, such as hirsutism (excess hair growth).

6. Fertility Treatments: If you are experiencing difficulty conceiving, assisted reproductive technologies may be considered.

In conclusion, it is essential to follow up with your healthcare provider regarding the blood tests and discuss the best course of action based on the results. Starting treatment without a complete understanding of your hormonal profile may not address the underlying issues effectively. Regular monitoring and a tailored treatment plan can help manage PCOS symptoms and improve your overall health.

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