Polycystic Ovarian Syndrome

PCOS is the most common hormonal problem in women of reproductive age, affecting approximately 9% -13% of women (some experts think as much as 21%). Although PCOS is most commonly seen in younger women, it can also present for the first time in women who are in their 40s and 50s. We also know this condition runs in families. There is a 20-40% chance of a PCOS-patient having a mother or sister who is also affected. 

The cause of PCOS remains unclear, but experts do agree that Polycystic Ovarian Syndrome is a very complex condition which is most likely caused by both genetics and environmental factors. 

Many women will have no symptoms at all or very mild symptoms. However, some more common symptoms are: 

• Irregular menstrual cycles and/or long cycles: abnormally long cycles can increase your risk of endometrial hyperplasia (thickened inner lining of the uterus) and endometrial cancer. 
• Acne: more severe than typical, may be on face, back, upper chest. 
• Hirsutism: hair growth on upper lip, chin, nipples/chest or abdomen. 
• Alopecia: hair loss, oftentimes at the hairline and/or at the part line. 
• High insulin levels: most often go undetected. High insulin levels put you at high risk of developing diabetes. 
• Weight gain/Inability to lose weight: many women with PCOS have a much harder time losing weight. If you are not trying to achieve a pregnancy, I do offer GLP-1 agonist therapy for women who qualify for this medication. See Weight Loss. 
• Infertility: PCOS accounts for ~ 27% of infertility cases.
• Miscarriage & Recurrent Pregnancy Loss (RPL): women with PCOS have a 20-40% higher risk of having a miscarriage as compared to women without PCOS, and some experience multiple miscarriages, ie: Recurrent Pregnancy Loss (RPL).  
• Pregnancy problems: higher risk of ectopic pregnancies, gestational diabetes, pre-eclampsia and premature birth. 
• High cholesterol: puts you at risk of heart attack and stroke. 
• Sleep apnea: puts you at risk of heart attack, stroke, and sudden death. 
• Psychological problems: depression, anxiety, eating disorders and/or disordered eating are all more prevalent in PCOS pts. 

For more information on PCOS and Infertility & RPL scroll to the bottom of this page where I have posted some recent research articles on treatments. For more in-depth information on Infertility and RPL see my webpage here. 

Most providers will make a diagnosis of PCOS by using the Rotterdam Criteria. 

A women must have only 2 of the 3 criteria mentioned below: 

1. Oligoovulation OR anovulation

• 1-3 yrs after first period: menstrual cycles < 21 days or > 45 days apart. 
• > 3 yrs after first period: menstrual cycles < 21 days or > 35 days apart OR you are having less than 8 cycles per year.
• > 1 yr after first period: menstrual cycles > 90 days apart. 

2. Clinical and/or Biochemical Hyperandrogenism (affects 60-90% of pts) 

• A diagnosis of "clinical hyperandrogenism" will be made if you have:  significant acne, alopecia (hair loss) and/or hirsutism (hair growth). 
• A diagnosis of "biochemical hyperandrogenism" will made if you have high androgens in your blood when we receive your laboratory results. 

3. Polycystic Ovaries (diagnosed by ultrasound on Cycle day 5 if you meet one of the following criteria: 

• You have at least one ovary with a total volume equal to or greater than 10 mls (hint: L x W x D = sum x 0.52 = total volume.  Ovarian total volume is reported in either mls or cc's. However, there cannot be a  dominant follicle nor a cyst present in the ovary making it larger. 
• You have a total follicle count of > 20 in one ovary. Only follicles that are greater 2 mm and less than 9 mm in size in counted to meet this criteria. 

You may view or download the American Society of Reproductive Medicine (ASRM) 2023 International Guidelines for diagnosing and managing PCOS by clicking the button below. 

Special Note: 

The Rotterdam Criteria recommends AGAINST doing an ultrasound to diagnoses PCOS in women until they are 8 yrs past their first period. However, many providers choose to do an ultrasound, which I will also want to do for you. 

The reason is because your HPO-axis has not yet had time to fully mature, and oftentimes there will be many follicles present in one or both ovaries. Younger women are also more likely to have large ovaries and irregular menstrual cycles. Thus, most experts agree to give a diagnosis of "LIKELY PCOS" until the pt is beyond 8 years past her first period, and monitor her over time.