Criteria for the diagnosis of PCOS include 2 out of 3 of the following: The ultrasound images at left show three examples of polycystic ovaries. Each gray area is an ovary and the dark spots are fluid-filled cysts within each ovary.
Establishment of the diagnosis of PCOS also involves exclusion of various other disorders such as congenital adrenal hyperplasia, Cushing’s syndrome, androgen secreting tumors, as well as thyroid or prolactin disorders which have a similar presentation.
If PCOS is present, your doctor may perform additional testing for lipids or glucose as PCOS is associated with elevated cardiovascular risk. Patients with PCOS also appear to be at higher risk for sleep disorders and depression. Ultrasound and endometrial biopsy may also be necessary to screen for hyperplasia (overgrowth) or more serious conditions of the endometrium (uterine lining). Although there is no cure at this time for PCOS, very effective treatments are available. In overweight and obese women, even a modest amount of weight loss (5-10%) may help menstrual cycles and ovulation to resume, so lifestyle modification with healthy diet and exercise is important. Insulin sensitizing agents such as Metformin have been associated with weight loss, improved ovulatory function, and possibly a reduced rate of miscarriage, and may supplement treatment.
If fertility medication is required, very often relatively inexpensive fertility pills (clomiphene citrate or letrozole) that require minimal monitoring can help to stimulate the ovaries to produce and release eggs. If this is unsuccessful, fertility shots (gonadotropins) can directly stimulate the ovaries to produce eggs, but do require more frequent ultrasounds and blood work. Surgical ovarian drilling could be considered as an alternative to these fertility shots. Finally, in-vitro fertilization (IVF) can be a very effective option in patients who have not been successful with prior methods.
