Polycystic ovarian syndrome explained

What are the symptoms?
Symptoms are varied and include:

• Irregular or absent periods. This is because a PCOS sufferer may be ovulating only infrequently, if at all.
• Infertility. Sometimes PCOS only comes to light when a woman seeks advice for infertility. Around 70 per cent of women who have problems conceiving because of abnormal ovulation also have PCOS.
• Obesity, oily skin or acne and hirsutism. These most visible symptoms of PCOS stem from excessive levels of androgens, which in women are produced in the ovaries, adrenal glands and in fat cells. Androgens are often called 'male hormones,' even though they are found in both men and women (they are usually present at much higher levels in men). Women with PCOS are more likely to gain weight and have more trouble losing it.
• Such symptoms alone are not enough to support a diagnosis of PCOS. They may only indicate 'hyperandrogenism,' which can be treated with anti-androgen medications.

How is it diagnosed?
There is no simple test. Your doctor will need to take a thorough history and physical examination, perhaps with some blood tests, to determine whether your symptoms are a result of PCOS. If he or she believes you have the condition you will be referred to a hospital specialist who may do further investigations.

Tests include:

• A look at your symptoms, especially a history of menstrual irregularities
• A physical examination, where your doctor will be looking for signs linked to high levels of testosterone, such as hirsutism, acne and obesity
• Blood tests. These will test level of androgens such as testosterone and the ratio of LH and FSH. A high ratio of LH to FSH, typically three-to-one, is characteristic of PCOS. These blood tests may also be used to rule out other conditions that give some similar symptoms, such as thyroid disease.
• An ultrasound scan, or a 'transvaginal scan,' where a small probe is inserted into the vagina to look for the characteristic picture of multiple cysts, is used but neither are definitive as it is very common for women without PCOS to have cysts. It is also common for women with PCOS to have no cysts. The ultrasound, however, can help confirm a diagnosis and examine the endometrial lining for abnormalities.

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