Here's What PCOS Really Is And How It's Diagnosed

Here's What PCOS Really Is And How It's Diagnosed

This guest blog was written by Dr. Alexsia Priolo, a licensed Naturopathic Doctor from Toronto, Canada.

Disclaimer: the information in this article is for educational purposes only and is not designed to replace individualized recommendations from a practitioner. Always check with your doctor before adding supplements or making changes to your treatment plan.


One in ten women live with polycystic ovary syndrome (PCOS), a complex metabolic and endocrine disorder. Although the word cyst is present in the name, you do not need to have cysts to be diagnosed with PCOS. Read on to learn more about the diagnostic criteria for PCOS, the four different types of PCOS, and the next steps you can take with your newfound PCOS knowledge.

Deconstructing PCOS

Because PCOS has multiple types and doesn’t always present the same, it’s considered a syndrome. In 2003, the Rotterdam criteria was established. You must meet at least 2-out-of-3 criteria in order to be diagnosed with PCOS.

The criteria are:

  1. Delayed ovulation or irregular menstrual cycles (anovulation).
  2. High androgen hormones.
  3. Polycystic ovaries on ultrasound.

Understanding the Rotterdam Criteria

1. Delayed Ovulation or Irregular Menstrual Cycles

Ovulation isn’t guaranteed each month, despite the butterflies or flowers you see on your app midway through your cycle. As you approach ovulation, your body will give you signs that it’s set to happen. You may notice a change in cervical fluid as it becomes more clear and stretchy. After ovulation occurs, you may also notice a slight increase in your basal body temperature, as progesterone is now being produced.

You can also determine if you’re ovulating by using an ovulation predictor kit or by testing your serum progesterone levels 7 days after you ovulate.

If you don’t ovulate this may be a cause of irregular periods. Here's how an irregular period is defined, depending on how many years you've been having a menstrual cycle:

  • 1st Year of Having Period: normal
  • First 1-3 Years of Having Period: less than 21 or greater than 45 days
  • After 3 Years of Having Period: less than 21 or greater than 35 days
  • After 3 Years of Having Period: less than 8 menstrual cycles per year

2. High Androgens

While all women have male hormones, higher levels of male hormones can be problematic. High testosterone can contribute to acne along your jawline or back, growth of facial and body hair, or alopecia (hair loss) in the front part of your scalp. The Ferrimen Gallway score is a quick visual tool used to assess male pattern hair growth and the Ludwig visual score helps to assess the degree of hair loss.

Remember you don’t need to be showing physical signs of high androgens in order to have them. This means that blood work needs to be done to determine where your levels are.

Some tests you should be asking your (Medical or Naturopathic) doctor to test:

    • Free testosterone
    • Total testosterone
    • Androstenedione
    • DHEAS

3. Polycystic Ovaries

Having a transvaginal ultrasound is the only way to determine if you have ovarian cysts. Although criteria continues to change as technology advances, you currently need 12+ follicles between 2-9mm or an ovarian volume bigger than 10cm in a single ovary.

If you got your first period less than 8 years ago, it’s not recommended that you get an ultrasound. At this life stage, you may have many follicles in your ovaries.

Additional Blood Work Considerations

Beyond looking at male hormone levels and figuring out if you’re ovulating, there are a couple of things to keep in mind if you have PCOS.  

The risk of Type 2 diabetes, impaired glucose tolerance, and gestational diabetes is increased in people with PCOS. This means that when you’re talking to your doctor about blood work, you should also ask for:

    • Fasting insulin
    • Fasting glucose

The values of these tests will determine if you have insulin resistance, a key feature of PCOS.

Moreover, because all people with PCOS are at higher risk for cardiovascular disease, screening should include:

    • Fasting lipid profile
    • Blood pressure measurement
    • Weight, height, and waist circumference

The 4 Types of PCOS

Now that you understand the diagnostic criteria better, you might be curious about the four PCOS types.  

Type A Type B Type C Type D

Criteria

  • Hyperandrogenism (excess androgens)
  • Anovulation/irregular periods
  • Polycystic ovaries
  • Hyperandrogenism (excess androgens)
  • Anovulation/irregular periods
  • Hyperandrogenism (excess androgens)
  • Polycystic ovaries
    • Anovulation/irregular periods
    • Polycystic ovaries

 

Signs & Symptoms

 

  • Increased BMI
  • Weight Increase
  • High Androgens
  • Polycystic Ovaries
  • Irregular Periods

*If you have Type A, you may also be insulin resistant, which may lead to an increased risk of diabetes and heart disease*

  • Increased BMI
  • Abdominal Weight Gain
  • Irregular Periods
  • Physical signs of high androgens

*Insulin resistance may also occur with this type*

  • BMI May be High
  • Abdominal Weight Gain
  • Increased androgens
  • Polycystic ovaries

*While periods may be regular, ovulation may not be occurring*

  • Irregular Periods
  • Polycystic Ovaries
  • Normal Androgen Levels
  • Normal BMI
  • Normal Waist Circumference

*There may be signs of insulin resistance*

Next Steps

Now that you’re well versed in the PCOS criteria and types, you can use this information to have conversations with your healthcare provider. While they’ll tell you that the first line treatment is the birth control pill, you can manage your symptoms through dietary and lifestyle interventions.

If you have an inkling that you may have PCOS, but aren’t 100% sure, there are a couple things you can do:

    • Track your period.
    • Figure out if you ovulate each month.
    • Get your blood work done.
    • Talk to your medical doctor about an ultrasound if either of the first 2 criteria may not be an issue (ie. blood work is optimal).

 
Alexsia Priolo, ND

Dr. Alexsia Priolo is a Naturopathic Doctor in Toronto, Canada with a strong focus on hormonal health, especially as it relates to the menstrual cycle and fertility. She knows that hormones can be complicated and affect periods and the skin – and everything in between!

That’s why she works with women to help them understand how their hormones work and provides actionable ways to make their hormones work for them – not against them.

Dr. Alexsia is licensed with the College of Naturopaths of Ontario, and is a graduate of the Canadian College of Naturopathic Medicine (CCNM). Prior to her studies at CCNM, she obtained an Honours Bachelor degree in Biology from York University. She is a member of both the Ontario Association of Naturopathic Doctors and Canadian Association of Naturopathic Doctors.

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