By: Paul Xiong and Igor Klibanov
You’re a woman who might have irregular periods, belly fat, and problems with fertility. Some of your friends with similar symptoms have a condition called “PCOS”. Or maybe you just Googled what your symptoms mean, and now you want to figure out “Do I have PCOS?”
You may or may not have PCOS, and I will help you find out in this article. While I can’t diagnose you through an article on the internet (nor am I a doctor anyway… to the disappointment of my Jewish mom), I can discuss how a diagnosis is made.
So in this article, you will find out:
● What is PCOS
● How is PCOS diagnosed
● What are the requirements to be diagnosed
● Some complications that may arise when diagnosed
● And what you should do in your current situation
But, before we begin, allow me to introduce myself.
Hi 🙂
My name is Igor, and I’m the author of 8 books on exercise and nutrition, including 3 Amazon bestsellers (one of which is Type 2 Diabetes Reversal Secrets).
I’m also a certified personal trainer who specializes in helping clients with PCOS lose belly fat, improve their insulin sensitivity, and get healthier.
Plus, I’ve written several articles on PCOS, like How to Lose Weight with PCOS, Workouts for PCOS, and others.
With that out of the way, let’s get started on our first topic:
What is PCOS?
Since you want to diagnose your condition, I’ll assume you have no idea what PCOS is in the first place. Essentially, PCOS or polycystic ovary syndrome is when many cysts have grown on your ovaries and result in many symptoms. And just so you know, PCOS is a condition that only affects women… since men don’t have ovaries. Unless they are what Arnold Schwarzenegger calls “girly men.”
So, “what are the symptoms?” There is a long list of PCOS symptoms that you may experience like: ● Infertility or difficulty getting pregnant
● Irregular periods (occur less than usual and/or prolonged periods)
● Excessive weight gain (especially around the belly) and weight loss difficulties
● Excess hair on your face, chin, chest, fingers, toes, or other areas of your body where males traditionally have hair (male-pattern hair growth)
● High blood glucose and/or high insulin (insulin resistance)
● Skin problems like acne on your face, back, or chest. Also darkening of the skin on your neck, groin, or under your breasts
● Fatigue and a lack of energy
● May form flaps of skin, also known as skin tags, on your neck or in your armpit area ● Headaches
● Moodiness
● Pelvic discomfort
● Hair loss or balding
● And trouble sleeping
But, this is not what you came here for. You want to know how to diagnose PCOS. A diagnosis requires diagnostic criteria. So let’s talk about that.
Diagnostic Criteria
Polycystic ovary syndrome can be difficult to diagnose because some of its symptoms have a variety of potential causes that are not always a result of PCOS. That’s why medical professionals use the diagnostic criteria that outline specific requirements a woman needs to meet in order to be diagnosed or confirmed with this condition.
While the criteria vary from country to country, most do agree on 3 of them:
● Irregular or infrequent periods
● High levels of androgens (these are male hormones – not just testosterone)
● And multiple cysts on the ovaries
The main symptom you experience with PCOS is irregular periods. A perfect menstrual cycle is considered to be every 28 days, and a normal cycle varies from 24-32 days (4 days above and below 28).
Women normally have 12-13 periods per year, so anything less than 12 would be considered an irregular or infrequent period, and increases your chance of PCOS. That is one criterion we check for.
Another is high androgen levels. Androgen is not a single hormone, but a group of masculinizing hormones (because men have greater amounts of these). The big 3 androgens are:
● Testosterone
● Androstenedione
● And DHEAS (dehydroepiandrosterone sulfate. Try using that in Scrabble 😉 )
So here’s a little chemistry lesson about androgens: your body contains sex hormones that are floating around in the blood, but not by themselves, and are instead bound to a molecule, called a “carrier protein”. For hormones like testosterone, estrogen and progesterone, this is known as sex hormone-binding globulin or SHBG.
The SHBG carries sex hormones throughout the blood to reach wherever they need to go, whether that’s the muscle, hair, ovaries, testicles, or whatever cell. Free testosterone is testosterone without SHBG (hormones not in the blood traveling) and how much is actually inside the cells. Total testosterone is another term which is all testosterone throughout the body including SHBG in the blood.
Cholesterol converts into many hormones, one of which is DHEA, which can’t be measured. That’s why we use DHEAS, which is a good proxy for DHEA. It then converts to androstenedione. Androstenedione gets converted to testosterone. Testosterone gets converted into estradiol (the main premenopausal estrogen). A rise in these hormones (high levels of androgens) is a precursor to PCOS.
Original source here.
Now let’s go on to the final criterion, which is anomalies in the ovaries. Medical professionals will look for multiple cysts on the ovaries, hence polycystic ovary syndrome. If you weren’t aware, the fluid in ovarian follicles protects the egg as it develops and breaks when the egg is released. But sometimes, a follicle shrinks after the egg is produced or fails to release an egg or its material. If this occurs, the follicle may enlarge and develop into a cyst that is filled with air, fluid, or other substances. This means you have polycystic ovaries.
Now, you don’t need all 3 to be diagnosed with PCOS. Women that have at least 2 of the 3 requirements are diagnosed with the condition.
But, how do we know if we even meet the criteria?
How to Diagnose PCOS
Because of the way the diagnostic criteria are set up, there is no single test that checks for PCOS. It’s really a combination of tests, and also why diagnosing PCOS can be challenging.
The diagnosis of PCOS includes 3 tests. One for each criterion:
● Physical/pelvic exam and/or ultrasound exam
● Blood test
● And symptom exam
The physical exam looks for irregular cyst growth. A tool called a speculum is used to help to look for any abnormalities (like cysts, masses, growths, etc.) in your body that shouldn’t be growing on the reproductive organs, especially the ovaries. An ultrasound may also be used, which uses sound waves to produce images of structures within your body, and in this case, can show whether you have a high number of cysts on your ovaries.
Blood tests look for high androgen levels. This will be your normal blood test procedure by taking a sample of your blood using a needle attached to a syringe or special container that is inserted into the vein. Don’t worry, you may feel a slight pricking or scratching sensation as the needle goes in, but it shouldn’t be painful. Blood tests may also be used to check your insulin resistance/sensitivity, which are usually (but not always) elevated in women with PCOS.
Then, there is the symptom exam. This test does not require any device and instead, you would be asked a series of questions about your medical history. Remember the large list of PCOS symptoms at the beginning? Medical professionals want to check if you are experiencing any of those symptoms, namely your menstrual cycles. Some sample questions your doctor may ask are:
● Frequency. Are your periods regular (between 24-32 days) or irregular? How often do you get periods?
● Pain. Is there pain associated with having a period?
● Bleeding. How much bleeding do you experience? Excessive or deficient amounts of bleeding (a woman should lose a certain amount of blood every day of her period)?
● Weight changes. How much does your weight change? Are the fluctuations throughout your periods really large?
And other than your menstrual cycle, your doctor will also ask about your:
● Medications. What medications are you taking (if any)? Medications that could contribute to PCOS or medications to help PCOS.
● Supplements. Do you take any vitamins, minerals, protein, herbs, or anything else?
● Diet. What’s your diet like?
● Stress levels. What are your stress levels? Stress levels affect hormones (the big one, being cortisol) and not just androgen levels.
● Sleep. How well are you sleeping? What time do you go to bed? How long does it take to fall asleep? Do you wake up throughout the night (and if so, how many times)? Do you wake up feeling refreshed, or tired? Do you have the same sleep schedule every day?
While discussing your symptoms, you will also get asked about your family’s medical history of PCOS and/or type 2 diabetes. If women in your family tree like your mother, aunts, sisters, and female cousins had those conditions, that is a higher chance that you could have it as well (but not always guaranteed).
In addition, you’ll be examined for any visible symptoms like male-pattern hair growth, acne, and discolored skin. All of which are symptoms I mentioned earlier. You may even get screened for your blood pressure and BMI (body mass index).
Now you can see why we require multiple tests. Because each test is designed to only look for 1 criterion and is unable to look for the others. And before you ask, no, you don’t need to have all 3 tests. If you are diagnosed within the first 2 tests, there is no need for the final test, although no harm in it.
Complications of PCOS
PCOS starts off as a reproductive issue, but there’s often “collateral damage” (complications), where other systems of the body are negatively affected as well, like the nervous system, cardiovascular system, and others.
To check for “collateral damage”, a good practitioner will run additional tests (that aren’t diagnostic) to test for complications of PCOS.
Some complications that a practitioner would look for are:
● Cholesterol and triglycerides. If they are high, they can increase the risk of heart disease
● Blood glucose. Many women with PCOS have insulin resistance
● Fasting insulin or C-peptide. Check if your body is insulin resistant or insulin sensitive. You might have good blood sugar levels, but require an excessive amount of insulin to make your blood sugar good.
● Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). Brain hormones that are released by a part of the brain called the “pituitary gland.” These hormones go from the brain to the ovaries and tell the ovaries to either start menstruating or make estrogen. These tests help assess where the problem is – in the brain, or in the ovaries.
● Sleep apnea. Many women with PCOS have sleep apnea, which means they wake up hundreds of times throughout the night because they can’t breathe, for such a short moment that they don’t even remember it.
● Anxiety and depression. Sometimes could precipitate PCOS or be a consequence of PCOS. Questionnaires are used to check for anxiety and depression.
Just to reassure you, these complications are not always going to happen. With all that being said:
What Should You Do About PCOS?
As you know (hopefully you’ve been reading) there are 3 diagnostic criteria for PCOS. You need to have at least 2 of the 3 diagnostic criteria to be diagnosed with PCOS.
Using the symptom check alone may give you a good idea if you require a physical exam or blood tests. So start by asking yourself, “what is my menstrual cycle like?” “am I getting enough sleep?” “Do I have some of these symptoms?”
Ultimately, it’s probably not a good idea to self-diagnose yourself for PCOS online (or any other condition for that matter). Please consult a medical professional if you suspect you have PCOS, and you should now know what to expect when getting diagnosed. You should now have a better idea of what to expect when you’re diagnosed.
After getting diagnosed with PCOS, it’s not the end of the world. There are ways to deal with it, both with medications and without. My specialty is on helping women with PCOS without medications – using exercise, nutrition, and supplements.
You can refer to my articles: How to Lose Weight with PCOS and Workouts for PCOS to help you with that.
But If you want some personalized help with your PCOS (and I would encourage you to), just fill out the application form on our home page.
