Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions affecting Australian women, with prevalence estimated at approximately 8 to 13 percent (Bozdag et al., 2016). Diagnosis can sometimes take time, and a clinical assessment helps ensure more of the relevant picture is considered.
This article covers what PCOS actually is, how diagnosis is meant to happen, and what comes after the label.
What PCOS is, and isn’t
PCOS is an endocrine and metabolic condition, not just a reproductive one. The three diagnostic features (the Rotterdam criteria, used internationally) are:
- Irregular or absent ovulation: cycles longer than 35 days, fewer than 8 cycles per year, or none at all
- Clinical or biochemical signs of androgen excess: acne, hirsutism (unwanted hair growth in male-pattern locations), or elevated androgen markers on bloods
- Polycystic ovarian morphology on ultrasound: multiple small follicles arranged around the ovary’s edge
A diagnosis requires two of the three. Critically, you don’t need to have polycystic-looking ovaries on ultrasound to have PCOS. The name is genuinely misleading.
PCOS is not:
- A guarantee of infertility
- Caused by being overweight (although insulin resistance, which often accompanies PCOS, can contribute to weight gain)
- The same condition in every woman. There are different presentations, and they need different management
What a proper PCOS workup includes
A proper diagnostic workup looks at the whole picture, not just one piece:
Endocrine pathology. LH, FSH, reproductive and metabolic markers, SHBG, prolactin and related endocrine indicators as clinically indicated.
Metabolic markers. Fasting insulin, fasting glucose, HbA1c, full lipid panel, and liver function. Insulin resistance is estimated to be present in approximately 70% of women with PCOS (Teede et al., 2018), and may shape both the symptom pattern and the treatment approach.
Thyroid function. TSH, free T3, free T4, antibodies. Thyroid dysfunction can occur alongside PCOS and may change the management approach.
Pelvic ultrasound. Ideally performed by a trained sonographer, with attention to ovarian volume and follicle count.
A symptom and cycle history. Including weight pattern, skin and hair concerns, mood, fatigue, family history and reproductive goals.
A diagnosis based on a single blood test or a passing ultrasound mention may be incomplete and can lead to a less targeted treatment approach.
What a PCOS management approach may include
There are several first-line management approaches for PCOS that your clinician may consider, and for some women it’s the right tool, particularly for cycle regularity, acne and hirsutism. But it’s not the only tool, and it doesn’t address the underlying metabolic picture. Any treatment is only considered if deemed medically appropriate. Possible outcomes also include lifestyle advice, monitoring, referral, or no treatment.
A modern PCOS care plan typically combines:
Metabolic management. Medication options your clinician may consider for insulin resistance, inositols (myo-inositol and D-chiro-inositol) increasingly supported by evidence, additional management options where indicated, and a nutrition and resistance training plan that targets insulin resistance specifically.
Androgen management. Your clinician may consider medication options for hirsutism and acne, often combined with cosmetic measures like laser. Management plans are individualised and never compulsory.
Cycle and ovulation support. When pregnancy is the goal, your fertility clinician can discuss ovulation induction options that are current first-line. When pregnancy isn’t immediately on the horizon, regular cycles can be supported through options your clinician will discuss, depending on what fits.
Mental health support. Studies have observed that PCOS may be associated with higher rates of anxiety and depression (Cooney et al., 2017), and these can be discussed and addressed as part of your care, where clinically appropriate.
Long-term monitoring. Research links PCOS with longer-term metabolic and gynaecological health considerations (Cooney et al., 2017). Ongoing review with your usual healthcare team is part of good care.
What it isn’t
PCOS isn’t a verdict. It isn’t a “lifestyle problem”, although lifestyle is one of several effective levers. It isn’t only about fertility. And it isn’t something where one prescription, given once, finishes the conversation.
A care plan for PCOS should evolve as your goals do, through cycle regulation in your 20s, fertility in your 30s, metabolic monitoring in your 40s, and beyond. That requires a clinician who’s still in the conversation a year from now.
This article is for general information only and should not replace individual clinical advice. Individual results vary based on your individual circumstances. Assessment findings do not guarantee a particular outcome.
Telehealth is not suitable for all health concerns. Your practitioner may recommend in-person assessment, urgent care, GP review, specialist referral, further investigation or no treatment depending on your circumstances.
References
- Bozdag, G., et al. (2016). The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Human Reproduction Update, 22(4), 495-514. doi:10.1093/humupd/dmw023
- Teede, H.J., et al. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Nature Reviews Endocrinology, 14(10), 602-618. doi:10.1038/s41574-018-0064-2
- Cooney, L.G., et al. (2017). Beyond fertility: polycystic ovary syndrome and long-term health. Fertility and Sterility, 108(4), 555-565. doi:10.1016/j.fertnstert.2017.09.014
