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PCOS – Polycystic Ovarian Syndrome

How is PCOS diagnosed?

There are a few different classifications, NIH classification which is the least specific, Androgen Excess and PCOS Society classification which is the most stringent, and the most commonly used Rotterdam Criteria.

We use the Rotterdam Criteria where you need to meet 2 out of the 3 categories

  1. Oligoovulation/anovulation (not ovulating/having irregular periods –periods usually occur every 21 to 35 days so if you get a period every 45days that is considered irregular.  Some patients have no periods at all)
  2. Polycystic ovaries on ultrasound (ovaries have a distinct appearance, young patients with lots of eggs can be tricky to diagnose)
  3. Clinical and/or biochemical signs of hyperandrogenism (male hormones)


Why is it important to make a correct diagnosis of PCOS?

Making the correct diagnosis of PCOS is essential as there are multiple syndromes with similar signs and symptoms which can mimic the disorder but require different treatments. So PCOS can only be made, after a comprehensive workup and the more serious endocrine disorders are ruled out.

PCOS is also associated with risks of developing future systemic illnesses like diabetes and heart disease so these should also be monitored by your physician.


What should I do if I think I have PCOS?

First thing is to make an appointment with your obstetrician/gynecologist. Family doctors are great for routine pap smears and such, but for a full evaluation see your gynecologist.

They will order bloodwork and an ultrasound to start. For patients not seeking to conceive, various treatments are available which may alleviate symptoms and regulate your periods.


What if I want to get pregnant and I have PCOS and irregular periods?

Once the diagnosis is established and fertility is desired most patients will undergo ovulation induction. Your ob/gyn can start you on an oral medications (Letrozole and/or Clomid and with certain indications metformin). These medications are meant to help you ovulate an egg so that you can try to conceive.


When should I see a reproductive endocrinologist and infertility specialist (REI) for my PCOS?

If you are trying to conceive and have tried 3-4 cycles of ovulation induction with your ob/gyn and still have not achieved pregnancy then you should consider seeing an REI. You may need further evaluation of your fertility. REI’s are also trained to perform more advanced reproductive techniques such as hormone injections and in vitro fertilization, or IVF.

Feel free to reach out to our clinic if you have more questions or want to set up an appointment to review your case.