The PCOS Diagnosis
As a fertility specialist, I see patients every single week who are struggling with the challenges of polycystic ovarian syndrome, or PCOS. This complex hormonal condition affects up to 10% of women, and yet it is often misunderstood and underdiagnosed. That's why I'm excited to dive deep into the latest updates on how we diagnose PCOS, so that more women can get the care and support they need.
Revising the Diagnostic Criteria
For years, the standard for diagnosing PCOS has been the Rotterdam criteria, which required two out of three key features: irregular or absent periods, clinical or biochemical signs of high androgens, and the presence of polycystic ovaries on ultrasound. But the truth is, this approach had some real limitations, especially when it came to younger women and those who had been on hormonal birth control for a long time. That's why I was so encouraged to see the European Society for Reproductive Medicine (ESRI) recently release a comprehensive new guide on PCOS diagnosis and management. One of the biggest changes is a more stepwise approach to reaching the PCOS diagnosis, which I think is going to be game-changing.
First Steps to Diagnosis
The first step is to assess whether a patient has irregular menstrual cycles and clinical signs of high androgens, such as acne, excess facial/body hair, or male-pattern baldness. If these criteria are met and other potential causes have been ruled out, then the diagnosis of PCOS can be made. But if the patient only has irregular cycles or high androgen signs, but not both, then additional testing is required. This is where the role of anti-Müllerian hormone, or AMH, becomes so important.
The Role of AMH
AMH is a hormone produced by the granulosa cells surrounding the follicles in the ovaries, and in women with PCOS, the ovaries tend to have an increased number of small follicles, leading to higher AMH levels. The new guidelines recommend using an AMH level of 8.5 ng/mL or higher, or twice the normal range, as part of the diagnostic criteria for PCOS. This is a significant change, as AMH testing was not widely used a decade ago, but is now considered a valuable tool in the PCOS diagnosis. Importantly, we have to be mindful that AMH levels can be impacted by factors like age, BMI, and hormonal contraceptive use. For example, AMH tends to peak in the early 20s and decline with age, and can be artificially lowered by the birth control pill. So we have to take these variables into account when interpreting the results.
Ruling Other Conditions Out
Another key aspect of the updated PCOS diagnosis is the emphasis on ruling out other potential causes of irregular periods and androgen excess. This includes conditions like thyroid disorders, hyperprolactinemia, congenital adrenal hyperplasia, and androgen-secreting tumors. This is especially important for younger patients, as irregular cycles are quite common in the first few years after starting menstruation. You see, simply having high AMH or polycystic ovaries on ultrasound is not enough to diagnose PCOS in adolescents - other potential causes must be thoroughly investigated. We have to be really careful not to over-diagnose PCOS in this population, as irregular periods and high egg counts are actually quite normal during that transition into puberty.
The Importance of An Accurate Diagnosis
Getting the PCOS diagnosis right is so crucial, because it opens the door to the appropriate management and treatment. Women with PCOS face an increased risk of serious health issues like endometrial cancer, diabetes, and cardiovascular disease. Knowing they have PCOS allows them to take proactive steps to monitor and address these concerns. Additionally, an accurate PCOS diagnosis is vital for those seeking fertility treatment. The hormonal imbalances and ovulatory dysfunction associated with PCOS require specialized care and therapies to optimize the chances of conception. I'm hopeful that these updated diagnostic guidelines will lead to more women receiving the PCOS diagnosis they need, while also reducing the risk of over-diagnosis, especially in younger populations. By taking a more comprehensive and evidence-based approach, we can ensure that PCOS is properly identified and managed, empowering women to take control of their health. If you suspect you may have PCOS, I encourage you to have an open discussion with your healthcare provider. Together, we can navigate the diagnostic process and develop a personalized plan to address your unique needs and concerns. With the right support, women with PCOS can thrive and achieve their goals, whether that's managing their symptoms, optimizing fertility, or simply feeling their best.
