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There is no one test or marker that can determine a diagnosis of PCOS. Rather, diagnosis is determined a collection of different blood tests. At present, there are three different diagnostic criteria for the diagnosis of PCOS, namely the NIH, Rotterdam and AE-PCOS criteria. Most clinicians use the Rotterdam Consensus Criteria which suggests a woman must have at least two of the following:
1. Hyperandrogenism
Hyperandrogenism refers to the excessive presence of androgens in the body. Whilst its presence its not necessary for a diagnosis of PCOS (if using the the Rotterdam Criteria), it is considered by many as the hallmark of PCOS. Symptoms typical of excess androgens include excessive body hair (hirsuitism), oily skin, acne and male pattern hairloss known as androgenic alopecia. Blood tests are sometimes carried out to check androgen levels in the blood if clinical hyperandrogenism is not so apparent. Markers frequently tested include free testosterone, total testosterone, -androstenedione, dihydrotestosterone
and DHEA-S.
2. Menstrual irregularities (Oligo-anovulation)
The majority of women with PCOS will present with some menstrual irregularity. Some women tend to have very long cycles where they may ovulate less frequently than the average woman (oligomenorrhea), others may have monthly periods but may not ovulate every cycle (anovulatory cycle), whilst others may not have periods at all (amenorrhoea).
3. Polycystic ovaries on ultrasound findings
Contrary to the name, this refers to a finding of several small follicles (not cysts) in at least one ovary that are visible on ultrasound. It should be noted that polycystic ovaries on ultrasound are not uncommon amongst the general population and women may have polycystic ovaries without having PCOS.
Phenotypes and other signs and symptoms
The different ways in which PCOS is expressed is often referred to as the different phenotypes (outlined in Fig 1). Knowing your 'type' or phenotype is particularly useful, not only for your own knowledge, but also for other healthcare professionals that you may be seeing to better manage your PCOS. So if you have been given a diagnosis of PCOS, always encourage your doctor to give you more details about your diagnosis.
Another common phenomenon in PCOS is the presence of insulin resistance. Whilst not a diagnostic criteria for PCOS, insulin resistance is seen in a large population of women with the condition. It is considered both a symptom as well as a contributing factor. Insulin is a hormone produced by the pancreas and controls the amount of sugar (glucose) in our blood. It helps move glucose from the blood into cells, where it is broken down to produce energy. Insulin also plays an important role in regulating ovulation.
High levels of insulin in the blood (hyperinsulinemia) however, as seen in women with insulin resistance and PCOS, is known to impact ovulation negatively through its contributing role in androgen production (Fig 3). Hallmark signs of insulin resistance include weight gain, difficulty to loose weight, as well as velvety dark skin patches known as acanthosis nigricans. It interesting to note that insulin resistance also be present in women with PCOS who have a healthy weight.
Management of PCOS and the role of acupuncture and Chinese medicine
Mainstream treatment of PCOS typically will depend on the clinical presentation. For example, if there is impaired ovulation the oral contraceptive pill is often prescribed (when not actively trying to conceive), or different medications that help regulate/promote ovulation. If insulin resistance is a concern, medication to promote insulin sensitivity, which in turn can help promote ovulation, may be given.
There are many known lifestyle changes known to help better manage PCOS. These include increasing physical activities/exercise, receiving correct nutritional support, weight loss where necessary, stopping smoking and better managing our stress.
The approach Chinese medicine takes in the management of PCOS is similar to that of mainstream approaches in the sense that its primary concern is to first regulate menstruation. Unlike the approach of prescribing the oral contraceptive pill, however, treatment with Chinese herbs always aims to promote ovulatory cycles and does not switch off this process. Treatment is always tailored to the individual, and always in accordance to the principles of Chinese medicine.
Over the last decade or so, some studies have attempted to investigate the effect acupuncture and Chinese herbal medicine may help in the management of PCOS. Whilst alot more research is needed, it has been suggested that both acupuncture and Chinese herbal medicine may act through reducing blood glucose and lipid levels, increasing insulin sensitivity, facilitating weight loss, enhancing blood flow to the reproductive organs, as well as regulating endocrine, neuroendocrine and metabolic disturbances
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