The Sanatio Blog

Womens health

PCOS -Being told you have it when you don’t is a problem.

That’s the conclusion of a recent British Medical Journal study called: Are expanding disease definitions unnecessarily labelling women with polycystic ovary syndrome?

The study makes the case that PCOS is being overdiagnosed and causing women a lot of unnecessary distress and worry. There is an increasing prevalence of women coming into the clinic with PCOS yet they are just going through a temporary state of anovulation (irregular periods). This can be due to the early years as your periods start to regulate, or that you have just come off the pill. Unfortanlyt for these women they get slapped with the label of PCOS.

Thanks to the wonderful Lara Briden; here are a few things to understand.

PCOS cannot be diagnosed by ultrasound

Bottom line, the ultrasound finding of polycystic ovaries does not mean very much. Why? Because it’s a common finding. It’s normal for all women to sometimes have a higher number of follicles. And it’s normal for young women to frequently have up to 25 follicles per ovary. (Remember, follicles are not abnormal structures—they’re the developing eggs! You have more eggs when you’re young.)

Tip: Experts all agree that ultrasound cannot be used to diagnose PCOS in young women. That’s why the new international PCOS guidelines state that “ultrasound is now not recommended in diagnosis in those within 8 years of [the start of periods].”

PCOS cannot be diagnosed by ultrasound and, at the same time, it cannot be ruled out by ultrasound. It’s possible to have a perfectly normal ultrasound and still have PCOS!

Tip: PCOS is both overdiagnosed and underdiagnosed. Know someone who can’t lose weight and has irregular periods? She could have PCOS.

PCOS cannot be diagnosed when you’re young

Polycystic ovaries, irregular cycles, higher levels of androgens (male hormones), and even mild insulin resistance are all normal and healthy during puberty. That’s why many experts recommend that PCOS not be diagnosed until at least three years after the onset of periods.

Tip: Pain is not a symptom of PCOS so if pain is your main symptom then there’s something else going on.

Other experts go further and point out that the prevalence of PCOS falls rapidly after age 25, indicating that for at least for some women, PCOS is temporary and can be outgrown.

PCOS can be temporary after the pill (post-pill PCOS)

Another temporary reason to have PCOS is coming off the pill. It happens for several reasons.

  • Hormonal birth control can cause or worsen insulin resistance and is a major contributor to insulin-resistant PCOS. (Read 4 Types of PCOS.)
  • Hormonal birth control causes ovarian dysfunction, which of course, it’s meant to do. For some women, the normal ovarian function will resume once birth control is stopped, but for some women, it does not—at least not straight away.
  • Coming off a “low androgen index” pill such as Yasmin can cause a temporary surge in androgens. While your androgens are high, you may qualify for a PCOS diagnosis, but your androgens should come down again after a year or two.

You might be thinking, “but surely I would not have been given a PCOS diagnosis when it’s only a temporary post-pill situation?” Unfortunately, yes, you could have been.

You might have hypothalamic amenorrhea (HA)

Hypothalamic amenorrhea is the situation of losing periods due to undereating and unfortunately, it is routinely misdiagnosed as “lean PCOS.”

The confusion happens because the two conditions share a number of symptoms including irregular periods (or no periods), polycystic ovaries, high anti-mullerian hormone (AMH), and even mild facial hair.

One of the best ways to distinguish PCOS from hypothalamic amenorrhea is with the blood test luteinizing hormone (LH). When measured on day 3 of your cycle (or random day if you have no cycle), LH is high in PCOS and low in HA.

 Tip: LH increases with age so there is no “perfect” number for LH. What matters is how high or low it is compared to FSH on day 3 of your cycle.

PCOS hormones
PCOS – what is really going on

It’s important to get this right because the treatment is very different. For PCOS, you may need to restrict your diet; for HA, you need to eat more!

What next?

If you’re concerned about your hormones and you aren’t feeling well and healthy, book an appointment to discuss your health.

 

Orignal article source – Maybe You Don’t Have PCOS –  by 

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