PCOS Diagnosis, Signs + Symptoms
If you’ve just been given a diagnosis of Polycystic Ovary Syndrome (PCOS), or suspect you may have it, it is likely you are feeling overwhelmed, confused + apprehensive about what this means for your health + fertility.
Sometimes, being given a diagnosis can feel relieving — finally having a name for the frustrating symptoms you’ve been dealing with for a long time. However, this can quickly be overrun by stress as you navigate this new diagnosis + try to figure out what is best for you.
Fortunately, PCOS is responsive to simple diet + lifestyle tweaks.
Although you should seek professional guidance on your path to healing, take comfort in knowing that with the right advice + support for YOUR body, you can take back control of your hormonal health.
In this article we’ll discuss:
What is PCOS?
Typical clinical PCOS signs + symptoms
How is PCOS diagnosed?
External environmental PCOS factors + why it’s important to understand
A summary of PCOS signs + symptoms
What can happen if PCOS is left untreated
Let’s get started!
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is a heterogeneous disorder characterized by hyperandrogenism + chronic an/oligoovulation (inconsistent or complete failure to release a dominant follicle from the ovaries).
Depending on what diagnostic criteria is used, 6-20% of reproductive aged women are affected by PCOS - That’s up to 1 in 5 women!
PCOS is a female syndrome of complex + interwoven pathophysiologies that disrupt the meticulously synchronized + tightly regulated hypothalamic–pituitary–ovarian (HPO) axis. The HPO axis is responsible for reproduction on an individual level + for reproductive competence + ultimate survival of our species on a population level.
The HPO axis can be impacted in many different ways including both internal information (hormonal + neuronal) + external factors (environmental influences).
Typical Clinical PCOS Signs + Symptoms
The persistent hyperandrogenism is associated with impaired hypothalamic–pituitary feedback, luteinizing hormone (LH) hypersecretion, premature granulosa cell luteinization, aberrant oocyte maturation, and premature arrest of activated primary follicles.
Typical clinical features beyond anovulation + infertility include:
Hirsutism
Acne
Insulin resistance
Androgenic alopecia
Fatigue
Depression
Weight Gain
Irregular Menses
Polycystic Ovaries
The symptoms listed are by no means an exhaustive list, but are some of the most common.
How is PCOS diagnosed?
Historically, there has been several PCOS diagnostic criteria used by health professionals. The most common criteria used today is the Rotterdam criteria.
Based on the Rotterdam criteria, to be diagnosed with PCOS, you must meet at least two of the following three criteria (with other causes ruled out):
Oligo-ovulation or Anovulation
Clinical and/or Biochemical Hyperandrogenism
Polycystic Ovaries on an Ultrasound
Let’s break it down…
Oligo-Ovulation or Anovulation:
Oligo-ovulation means irregular and/or inconsistent ovulation, + therefore periods. This is most commonly seen as long cycles. Long cycles are longer than 35 days, but can even be up to 90-120 days between the start of one period bleed + the next.
Anovulation means not ovulating at all + therefore no period bleeds.
Oligo-ovulation or anovulation are common + arguably the most common feature of PCOS. This is due to the effects that excess androgens have on the ovaries; Follicles (immature eggs) become halted or stalled in their developmental process.
Usually, this means your body gives its best attempt to ovulate (often many times in one ‘cycle’), and either achieves ovulation (followed by a period bleed roughly two weeks later), or fails to ovulate (no period).
Clinical and/or Biochemical Hyperandrogenism:
Hyperandrogenism refers to an overproduction of androgens like testosterone + dehydroepiandrosterone sulfate (DHEAS).
Clinical hyperandrogenism refers to physical signs that your body is making too many androgens. Acne (especially on your chin), alopecia on your head and/or hirsutism of the face + body are the most common clinical presentations of hyperandrogenism.
You can also meet this criteria for diagnosis through documentation of elevated serum androgen concentrations (including testosterone, DHEAS + androstenedione) on blood tests.
One caveat: The importance of measuring androgens using high-quality assays such as liquid chromatography–tandem mass (LC-TM) spectrometry or extraction immunoassays. Testosterone levels are confounded by several problems, including assay sensitivities that are inadequate to accurately measure low concentrations, sparsity in evidence-based normal ranges, and assay interference due to other steroid molecules and/or sex hormone binding globulin (SHBG). In view of these constraints, it is important to recognize clinical hyperandrogenism as equivalent to biochemical hyperandrogenism when making a PCOS diagnosis.
Polycystic Ovaries on an Ultrasound:
The final criteria for diagnosis of PCOS is polycystic ovaries on ultrasound. This refers to the appearance of multiple follicles that are semi-developed, which you may hear referred to as a “string of pearls”. This is due the large number of small follicles side by side on the ovaries.
Having growing follicles is normal + in a healthy cycle, we have up to 12 developing follicles at one time, all racing to ovulation. One dominant follicle is released, and the others stop growing + are reabsorbed.
In PCOS, excessive ovarian and/or adrenal androgen secretion make it difficult to make it to this final stage of ovulation (hence why missing periods or very long cycles are a common feature of PCOS).
If ovulation doesn’t occur, there is no dominant follicle + all follicles keep growing a small amount, producing many underdeveloped follicles which can be seen on ultrasound.
External environmental PCOS factors…
Research over the past few decades suggests that internal + external factors during the preconception + gestational time period have an impact on the health of future generations. We call this epigenetic: external + internal factors that modify gene expression (whether a gene is turned on or off) rather than altering the genetic code itself.
These modifications in gene expression are inheritable. For example, if a woman had external influences, such as phthalate exposure, which modified the expression of a gene associated with increased risk of PCOS, that gene modification would be passed down to her offspring.
This may sound scary, but with proper education + awareness, this can also be an amazingly powerful tool to create health for future generations.
Why is this important?
First, let’s dispel the myth that your eggs are your eggs + there is nothing you can do to affect the long term health of your children, because that is just NOT true. Your health today determines your children’s, your grandchildren’s, and your great grandchildren's health for years into the future.
Second, understanding what epigenetic is + how powerful external factors (environment, lifestyle, diet, etc.) can be on the expression of genetics that determine health is empowering.
The educational foundation needed to truly understand why + how holistic, natural modalities (lifestyle + diet) work so incredibly well when addressing chronic health conditions, including PCOS.
Summary of PCOS Signs + Symptoms
The overarching reason for all PCOS symptoms is excess androgens.
There are different root causes that driving this excess in androgens + we will discuss those in the next blog post, “PCOS Phenotypes”. For now, it’s important to understand that all these seemingly unrelated symptoms of PCOS are actually driven by the same thing: ANDROGENS!
Missed or Irregular Periods
In the ovary, high circulating levels of LH, increased responsiveness to LH, + hyperinsulinemia contribute to premature arrest of antral follicle development + inhibits progression to ovulation. No Ovulation = No Period.
Weight Gain
Insulin resistance is the biggest contributor when it comes to weight gain in women with PCOS. Other contributing factors may include suboptimal mental health + under active thyroid.
Mental Health Issues
PCOS is associated with an increased risk of depression, anxiety, bipolar + obsessive compulsive disorder.
Hair Loss + Hirsutism
Excess androgens in women with PCOS can cause thinning hair on the head, aka androgenic alopecia, + atypical hair growth on the chin, chest + back.
Excessive Fatigue
There are many contributing factors to fatigue in women with PCOS, including hormone imbalances, nutrient deficiencies, under active thyroid, anemia, sleep apnea + mental health issues.
Acne
There are many contributing factors to acne in women with PCOS including excess androgens, hyperinsulinemia, gut dysbiosis, under active thyroid + inflammation.
If left untreated…
Beyond acute symptoms, PCOS can increase your lifelong risk of disease, including conditions like heart disease, diabetes, endometrial cancer + non-alcoholic fatty liver disease.
Pregnancy complications are also increased in PCOS due to higher incidences of gestational diabetes, pre-eclampsia, hypertension + caesarean delivery.
Luckily, there are so many natural solutions to managing your PCOS + reducing symptoms.
If you are looking for support or guidance, Vibrant Revival may have something to fit your personal needs:
One-on-One Guidance + Treatment Plan
Self-Paced Vibrant Fertility Revival Course
12-Week Vibrant Fertility Revival Group Program (Now Enrolling for Spring 2022!)
Fully healing from PCOS requires a whole-body approach + Dr. Jordan Dawson of Vibrant Revival is here to help!
About Dr. Jordan Dawson
Dr. Jordan Dawson is a Functional Medicine PharmD Practitioner (Functional Medicine Fast Track - Clinical Level 1), wife + mother of two. She's passionate about empowering women to take back control of their hormones + fertility, and holistically leading them to vibrant health + pregnancy!
More of Dr. Dawson's credentials:
Board Certified Critical Care Pharmacist
Board of Pharmacy Specialties
Board Certified Pharmacotherapy Specialist
Board of Pharmacy Specialties
Licensed Pharmacist, No. 19192
Colorado State Board of Pharmacy
Plant-Based Nutrition Certification
eCornell University
Certified Transformational Life Coach
Professional Development Standards Agency
Certified Mindfulness Life Coach
Professional Development Standards Agency
ACLS/BLS certification
American Heart Association
For more info + to view the full list of Dr. Dawson's extensive medical background, click here: https://www.vibrantrevival.com/new-blog/the-trusted-pcos-fertility-hormone-expert
To enroll in her 12-Week Vibrant Fertility Revival Program, click here: https://www.vibrantrevival.com/new-blog/vibrantfertilityrevivalprogram
Dr. Dawson's promise to you...
“I will listen to your goals, concerns + fears — then address them fully in a kind + compassionate way.
I believe in the body’s intrinsic ability to heal + will explore natural modalities to support your hormone, fertility + overall health.
I will make sense of modern medicine + holistic wellness, and their place in your health journey.
I will collaborate with you to achieve + maintain your highest health potential.”
For everything PCOS, fertility + hormones, from supplementation suggestions by Dr. Jordan Dawson to hormone-happy meal ideas, mental health management tips + much more, follow @VibrantRevival on Instagram: https://www.instagram.com/vibrantrevival
