Diagnosing Polycystic Ovary Syndrome, What’s New
Polycystic ovary syndrome (or polycystic ovarian syndrome) is the most common hormonal disorder that affects women of childbearing age, yet physicians often miss identifying the condition or attribute a woman’s symptoms to something else. These diagnostic missteps may improve if a new approach is used.
How to identify polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a condition in which a woman’s ovaries are usually (but not always) enlarged and have small cysts positioned on the outer edge of each ovary. These abnormalities typically cause women to have infrequent or no ovulation and therefore they have difficulty getting pregnant. The cause of polycystic ovary syndrome is not known, although it is characterized by abnormal levels of male hormones (androgens).
In addition to these characteristics, women with PCOS often also experience depression, high cholesterol, elevated blood pressure, acne, discolored skin, excessive facial and body hair, and weight gain. Presence of PCOS may include complications as well, such as stroke, type 2 diabetes, and heart disease. In fact, it’s been shown that women with PCOS have twice the risk for metabolic syndrome compared with women from the general populations.
Diagnosing PCOS continues to be problematic, which is why the findings of a new study from Istanbul University may help. The authors evaluated the role of anti-Mullerian hormone (AMH) in the diagnosis of PCOS using a population of 419 women with and 151 women without the syndrome.
AMH is produced by small growing follicles and so it is different from the other hormones measured to help diagnose polycystic ovary syndrome, as those hormones are related to ovulation, while AMH is not. More and more physicians are using AMH as a routine test in women undergoing assisted conception.
In the study, investigators measured levels of AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid-stimulating hormone (TSH). All the hormone levels were compared and the predictive value of AMH was analyzed.
Women with PCOS had significantly different levels of FSH, LH and estradiol, and LH/FSH ratio than those without the syndrome. In addition, women with PCOS had higher AMH levels than did controls (7.34 vs 2.24 ng/mL). Thyroid hormone levels were similar between groups.
The authors concluded that “AMH measurement is very valuable in diagnosis of PCOS patients,” and that “AMH level is a new and useful diagnostic tool in PCOS diagnosis.”
How is PCOS usually diagnosed?
Currently there is no one test to diagnose polycystic ovary syndrome. To make a diagnosis, doctors ask about typical symptoms such as menstrual changes and weight problems, as well as conduct a physical exam (including blood pressure and checking for abnormal hair growth) and pelvic exam (to check for enlarged ovaries), and take blood tests to check hormone and glucose levels. A vaginal ultrasound may be ordered to check the ovaries for cysts.
Several years ago, a research team developed a new cholesterol test called the VAP Cholesterol Test, which provided promising results. The test measures 22 different factors and shows a relationship between women who have PCOS and low levels of HDL2, a type of high-density lipoprotein (HDL).
September is PCOS Awareness Month, and so it's a good reminder for women who are experiencing symptoms of the syndrome to consult with their healthcare provider. Although diagnosing polycystic ovary syndrome continues to be a challenge, new ways to accurately detect the condition are being developed.
Anderson RA. What does anti-Mullerian hormone tell you about ovarian function? Clinical Endocrinology 2012; 77(5): 652-55
Coviello AD et al. High prevalence of metabolic syndrome in first-degree male relatives of women with polycystic ovary syndrome is related to high rates of obesity. Journal of Clinical Endocrinology and Metabolism 2009 Nov; 94 (11): 4361-66
Sahmay S et al. Elevated serum levels of anti-Mullerian hormone can be introduced as a new diagnostic marker for polycystic ovary syndrome. Acta Obstetricia et Gynecologica Scandinavica 2013 Aug 28. Epub ahead of print