Symptoms of polycystic ovary syndrome (PCOS) can vary from woman to woman, change with time, and are similar to symptoms associated with other conditions. This varied overlap of symptoms means that PCOS is often misdiagnosed or misunderstood. For these reasons, a set of guidelines known as the Rotterdam Criteria was developed in 2003 to aid in the diagnosis of PCOS or eliminate it from consideration.
Read on for a better understanding of the symptoms linked to PCOS, why they occur, and the Rotterdam Criteria that can help PCOS patients get diagnosed and receive proper treatment.
How Do You Know if You Have PCOS?
Due to the various symptoms that can overlap with other conditions, such as thyroid disorders, adrenal issues, high prolactin levels, or even puberty, it can be difficult for healthcare providers to diagnose PCOS based only on a patient’s symptoms.
Puberty, postpartum hormones, and stress can cause irregular menstruation, for example. Androgen and insulin levels can vary from month to month, and high LH levels compared to FSH are not always obvious in every woman with the condition, making blood tests unreliable for diagnosis. Lastly, not all women with PCOS have cysts on their ovaries.
Therefore, the Rotterdam Criteria were agreed upon by medical experts in 2003 as a guideline for diagnosing PCOS. Essentially, other conditions are ruled out, and PCOS is diagnosed when two out of the following three Rotterdam Criteria are present.
- Irregular or absent menstruation during the reproductive years, leading to a lack of ovulation (anovulation)
- Indicators of high androgen levels via a blood test or symptoms such as acne, excess facial or body hair, and hair loss on the scalp. (Hyperandrogenism)
- Polycystic ovaries are evident on an ultrasound. (Polycystic Ovarian Morphology)
That being said, even though the Rotterdam Criteria are still widely used for diagnosing PCOS in many adults, the guidelines for identifying it continue to be reviewed.
According to recently updated research by the National Institutes of Health (NIH), polycystic ovarian morphology (PCOM) is not required to diagnose PCOS in every patient, particularly for adolescents.
During puberty, when hormones like estrogen, progesterone, and testosterone fluctuate, and ovulation is not yet regular, it’s common to find small follicles on the ovaries that can appear like multiple ovarian cysts on an ultrasound. Therefore, the updated guidelines for diagnosing PCOS in adolescents are irregular menstruation and evidence of hyperandrogenism.
Research has also shown that identifying PCOM as a diagnostic criterion for PCOS is not always reliable in adults either. Some ultrasound machines are high-resolution, for instance, while others are too basic to identify or count ovarian cysts, and an ultrasound operator’s experience may also vary. For these reasons, high levels of Anti-Müllerian Hormone (AMH) are often substituted as a diagnostic criterion in place of PCOM.
How Do You Treat PCOS?
There is currently no cure for PCOS, but lifestyle changes like improving your diet and exercise, reducing stress, and taking inositol supplements to improve insulin resistance are recommended as the first line of treatment. For more severe cases, hormone therapy, medication against hypoandrogenism, diabetes medication, fertility treatment, or surgery may be advised.
Bearing in mind that several PCOS symptoms can persist throughout a woman’s lifespan, a natural treatment plan is always recommended first to avoid the patient taking medication for the remainder of their life.
Improved Diet
Because insulin resistance and weight gain are often linked with PCOS, diet is one of the first things to address. Eating a well-balanced diet rich in whole foods, vegetables, and fruit while limiting sugar, starch, and refined carbohydrates helps treat insulin resistance and reduce weight gain.
Regular Exercise
As well as helping to lose weight, regular exercise is known to alleviate stress, anxiety, and depression, which are symptoms that frequently arise in women with PCOS. Regular exercise, at least three times a week, also helps hormone balance, which, in turn, improves regular menstruation, ovulation, and fertility.
Inositol Supplements
Inositol is a natural B vitamin, naturally produced in the body to regulate insulin, metabolism, cholesterol, mood, and cell structure. Although there are nine types of inositol, supplementing Myo-inositol and D-chiro-inositol in a 40:1 ratio has proven the most helpful in improving insulin resistance, excess androgen production, fertility, depression, and weight gain in women with PCOS.
Indeed, from all the natural supplements and herbal remedies recommended and tested for managing PCOS, a regular 40:1 Myo-inositol and D-chiro-inositol supplement was proven most effective.
Our top pick is the Myo-inositol and D-chiro-inositol supplement from Intimate Rose, which also contains added Ashwagandha and Vitamin D for mental clarity and daily wellness. Check out the incredible reviews from real customers on their website. Some hadn’t ovulated or experienced regular menstruation since their early teens due to PCOS and the inositol supplement changed everything!
Medication, Hormone Therapy & Fertility Treatment
In more severe cases of PCOS, when insulin resistance is extreme, diabetes medication may be required. Hormone contraceptives are sometimes prescribed to balance the sex hormones, or fertility treatment is administered if patients are trying to conceive. Medication to lower excessive androgen production and treat facial or body hair growth, and baldness is also sometimes prescribed.
If symptoms fail to subside after medication and hormone therapy, or fertility treatment when trying to conceive, surgery to remove cysts from the ovaries could be the next step.
Conclusion
Even though diagnosing polycystic ovary syndrome (PCOS) is difficult due to the overlapping symptoms associated with other conditions, the Rotterdam Criteria and NIH criteria are guidelines to help. Although there are only three guidelines, the presence or absence of these features in patients can help rule out other conditions and aid in the diagnosis of PCOS.
Because PCOS is a lifelong condition, treatment typically begins with dietary changes, regular exercise, and Myo-inositol and D-chiro-inositol supplements at a ratio of 40:1 that can be safely sustained for years without adverse side effects. In severe cases of insulin resistance with PCOS, diabetes medication, hormone therapy, and hypoandrogenism medication are considered.
References
National Institutes of Health – What Causes PCOS? https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes
National Library of Medicine - Insulin and hyperandrogenism in women with polycystic ovary syndrome - https://pmc.ncbi.nlm.nih.gov/articles/PMC3846536/
National Library of Medicine - The role of gonadotropin‐releasing hormone neurons in polycystic ovary syndrome - https://pmc.ncbi.nlm.nih.gov/articles/PMC9232905/
National Library of Medicine - Diagnosis and management of polycystic ovarian syndrome - https://pmc.ncbi.nlm.nih.gov/articles/PMC10833093/
National Institutes of Health - Polycystic Ovarian Syndrome: Continued Education Activity - https://www.ncbi.nlm.nih.gov/books/NBK459251/
Intimate Rose - 7 Things to Know About Taking Inositol for PCOS - https://www.intimaterose.com/blogs/womens-health/inositol-for-pcos-info?