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Diagnosing PCOS, Polycystic ovarian syndrome symptoms

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What is PCOS?

Polycystic ovarian syndrome is an androgen excess disorder that affects between 5 percent and 10 percent of all women. PCOS is a syndrome, not a disease, which means that it is a collection of physical findings and symptoms that suggest a common disorder.

"There's a lot more to [PCOS] than just the fertility-related issues, and in fact, more often than not, I tell my patients: 'We know how to help you get pregnant — it may just take a little longer," says Anuja Dokras, MD, PhD, a reproductive endocrinologist with Penn Fertility Care and director of the Penn Polycystic Ovary Syndrome Center. "What I worry about are the other conditions associated with it, namely the high blood pressure, high cholesterol, diabetes, risk of metabolic syndrome, long-term risk of heart disease. My group and others have a paper in Fertility and Sterility showing an increased risk of mood disorders with depression and anxiety disorders in women with PCOS."

There are three uniform criteria for diagnosing PCOS have been developed over the last decade. They are:

  • Irregular or infrequent menstrual periods, typically six to nine per year.
  • Excessive hair growth on the face or body, or a blood test that shows elevated levels of male hormone.
  • An ultrasound that reveals the typical polycystic ovary appearance, with small, fluid-filled sacks known as cysts that commonly have a string-of-pearls appearance. Each small cyst represents a follicle, that contains a single egg that is attempting to develop to a stage where it will be ready to be released from the ovary.

"These are normal follicles that have eggs in them," Dr. Dokras says. " It's part of {a woman's] normal fertility but it has a very unique appearance, and that's how we make that third criteria as part of the diagnoses."

Dr. Dokras explains that the increased number of follicles are not really "cysts" as you would normally picture them; instead they are immature follicles. "I explain this to patients that they are never going to experience any kind of pain from these cysts. These cysts are not going to rupture, because it's really not a cyst, it's part of the normal follicles that all women have, and you just have more. They just don't release in a timely manner; hence you don't get a period every month. And you may not get pregnant right away in the month and year you decide — it may take a little longer, but that's it. The eggs are there."

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