PCOS Paradox; the most common and yet often overlooked problem

Over 5 million women in the USA have polycystic ovarian syndrome (PCOS) and yet many, don’t even know it. Estimates are that the cost of this manageable condition exceeds $4.4 Billion per year. Less than a quarter of the money is spent providing fertility related treatment. Ironically, earlier diagnosis and management could result in a tremendous potential for reducing cost and improving outcome as well as boosting pregnancy rates for women with this condition. So why is it so difficult to identify and diagnose this problem? It all comes down the diversity of the women that have PCOS.

The term “syndrome” refers to a group of signs or symptoms that occur together and are typically triggered by the same underlying condition. There is no single diagnostic finding that defines a syndrome but instead a necessary combination of concomitant features. PCOS, like any syndrome, represents a spectrum of clinical problems that can be very different depending upon each woman’s unique combination of findings. The result of this diversity has created a diagnostic dilemma.

To date, there are at least three different sets of guidelines that are used to define PCOS; National Institutes of Health (1990), Rotterdam Consensus Group (2003) and the Androgen Excess Society (2006). Each is well recognized and has its merits. The problem is that a patient may be defined as having PCOS by one doctor but not another depending upon which criteria they embrace. Personally, I feel that the Rotterdam Consensus Group represents the most organized attempt to define the vast number of presentations of PCOS. Using the Rotterdam Consensus Criteria, over 90% of the women whose infertility is impacted by this hormonal imbalance can be properly diagnosed and treated.

Better still, for women that want to get a quick estimate of their risk of having PCOS, I encourage you to review your symptoms by taking the PCOS quiz. Then check out the recent ACOG Practice Bulletin on PCOS. This publication will empower you with a summary of the latest information on the diagnosis and management of this common condition. In fact, it should even serve as the basis for a thoughtful discussion with your doctor on the treatment options available to improve your health, your quality of life and your fertility. Here are just a few key topics addressed in this bulletin:

  • Suggested evaluation including ultrasound criteria to confirm PCOS (p 938)
  • Who should be screened for Congenital Adrenal Hyperplasia (p 940)
  • There is no need for specific tests to justify the use of insulin sensitizing medications like metformin (pp 940-2) and the dose most commonly used is 1500 to 2000 mg/day.
  • Shaving does not increase hair follicle density or size of the hair shaft for women with hirsutism (p 944)

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