What is PCOS?
PCOS stands for Polycystic Ovary (or Ovarian) Syndrome. We will get into what all that means in a minute! There are several different "criteria" for diagnosing PCOS. This is a large part of the reason the diagnosis evades so many women until the syndrome has become very difficult to manage. Instead of having a proactive approach to diagnosing and treating PCOS, physicians will not diagnose the syndrome until they see certain criteria (symptoms) in the patients (us!). While this is technically what they are supposed to do according to the criteria that has been established by experts in women’s health to diagnose the syndrome, it is not helpful to the patients who have to suffer and essentially wait for their condition to worsen to the point of having visible symptoms. So who, then, are these experts that have decided the criteria for diagnosing PCOS?In your own research, you may have come across what is called the ‘Rotterdam Criteria’ in regards to the symptoms or diagnosis of Polycystic Ovary Syndrome. In 2003, the European Society for Human Reproduction/American Society of Reproductive Medicine (ESHRE/ASRM) sponsored a workshop in Rotterdam (a city in the Netherlands) to establish criteria for diagnosing PCOS. These criteria were later revised, and you can see the revised criteria below. The revised Rotterdam criteria require two of the three following criteria for the diagnosis:
oligo- or anovulation
hyperandrogenism (clinical or biochemical) and
follicle count on imaging
Additionally, is important to exclude other aetiologies (illnesses, diseases, syndromes, etc.) such as congenital adrenal hyperplasia, Cushing syndrome, and/or an androgen-secreting tumor before making the diagnosis.Ok, I know that’s A LOT of medical speak, but bear with me. Let’s take these one by one….
Oligo- or anovulation: PCOS is generally classified as an “anovulatory syndrome” meaning that ovulation (the release of an egg, and therefore, menstruation/your period) stops completely. However, because PCOS can be mild to severe, ovulation can either be sporadic (oligoovulation) or can stop altogether (anovulation).
Note: You may see Oligomenorrhea or Amenorrhea, or even oligo-amenorrhea. Menorrhea simply means menstruation (your period) and the prefixes mean the same thing, so oligomenorrhea is to have a sporadic period, amenorrhea is to have no period, and oligo-amenorrhea will generally be referring to the symptom of not having a regular period, whether it be sporadic or not there at all.
Hyperandrogenism (clinical or biochemical): Androgens are male sex hormones (think of testosterone, for instance). The presence of too many male sex hormones in the female body is called hyperandrogenism. This happens with PCOS and can cause both visible symptoms (known as “clinical”) or symptoms because of the excess androgens in your blood (“biochemical”).
Follicle count on imaging: One of the key signs of PCOS is in the name itself, polycystic ovaries. When women ovulate each month to release an egg, you can think of what is essentially a cyst (known as a follicle) is formed to release the egg. This is normal unless the follicle does not release the egg and does not break down like it is supposed to. This causes the follicle to stay on the ovary, and is where PCOS comes in. Doctors can see these cysts (follicles) on an ultrasound.
Note: The actual criteria requires the ‘presence of 12 or more follicles in each ovary measuring 2–9 mm in diameter, and/or increased ovarian volume (>10 ml)’I would encourage each one of you ladies to do your own research, and will always try include a citation of the information I directly reference in the post. Feel free to ask any questions you have, and I’d be happy to answer them. I had A LOT of questions when I was diagnosed and no one to ask. My goal is that this blog will be a community for every woman with PCOS, so that we can all share information with each other.I hope this was helpful! More about the symptoms and other criteria for diagnosis (NIH and Androgen-Excess Society Criteria) in another post. Feel free to request any information you would like me to post about!
References
Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil. Steril. 2004;81 (1): 19-25. Fertil. Steril. (link) - Pubmed citation
The Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS), Hum Reprod , 2004b, vol. 19 (pg. 41-47). https://doi.org/10.1093/humrep/deh098