PCOS, polycystic ovarian syndrome, is one of the most common metabolic and endocrine disorders in women of reproductive age. The condition has many contributing factors and symptoms, and the key features include obesity, hyperandrogenism and menstrual cycle disturbances. The health consequences of this condition are far-ranging and include type 2 diabetes, hypertension, infertility and coronary artery disease. Up to 70% of PCOS patients are obese and diabetic or glucose intolerant than non-PCOS women. They are at a higher risk of endometrial hyperplasia and ovarian and breast cancers. Though there are many PCOS characteristics, ovarian dysfunction is the main component, and hence, accurately diagnosing it is important. Healthcare providers perform blood tests, medical history, physical examination and ultrasound to confirm PCOS. Read on to know why the scan results are crucial to solving this diagnostic puzzle.
PCOS diagnosis is not straightforward. To declare that you have PCOS, you should meet the Rotterdam Criteria, which is the gold standard for PCOS diagnosis. This states that you should have two of the following conditions to be officially classified as having PCOS:
An ultrasound scan for PCOS is done to identify polycystic ovaries. However, since PCOS is a syndrome, its presence alone is not enough for a definitive diagnosis. But it provides valuable information during the diagnosis. When a routine ultrasound is done, as per a report by Lancet Journal, about 23% of women in their reproductive age have polycystic ovaries. But only about 5 to 10% have classic signs of PCOS like hirsutism, amenorrhea, infertility or obesity. Women with polycystic ovaries should not be diagnosed with PCOS until more tests are performed.
So, what other criteria to consider? High androgen levels, like testosterone, are among the main characteristics of this syndrome. This is seen in more than 60 to 80% of the cases and is one of the key factors for diagnosis. Since these hormones regulate many body processes, from metabolism to reproduction, it can lead to many symptoms of PCOS. So, the first step when checking the symptoms and lab findings is to exclude the disorders that may have caused these findings. Some conditions that show similar symptoms to PCOS but are different are:
Among the above conditions, differentiating it from thyroid disease is a challenge as some thyroid disease forms are common in women with PCOS. Additionally, some tests to diagnose thyroid disease are inaccurate in women with PCOS.
A transvaginal ultrasound means through the vagina is the most common scan for PCOS. It allows the healthcare provider to look at the internal structures like the ovaries and the womb more closely. The test can cause discomfort but typically does not take long. You will have to lie on your back with both your knees up, and a small ultrasound probe is inserted into the vagina. The sonographer will check the cervix and the uterus. The ovarian follicle will be counted and is called the AFC, Antral Follicle Count.
Antral follicles are immature egg containing structures that are present in the ovaries at the start of every period. These are 2 to 9 mm in size. A high AFC means that many immature eggs are present in the ovary waiting voraciously for the correct hormonal signals to grow and this may indicate PCOS. Women with PCOS produce more follicles in the ovary as a result of sex hormone fluctuations results in excessive male hormones(androgens). Every month, follicles are recruited by the ovaries and released when they mature to the fallopian tube and this event is disturbed resulting in Infertility.
To understand the difference between these two ultrasounds, it is important to learn what an external ultrasound is.
An external ultrasound is one that many people are familiar with. It is done to check the health of the unborn fetus during pregnancy. It is also used in adults and children to check various internal organs and diagnose potential problems. This scan is done by rubbing a gel on the skin and running a small probe on the body part being checked. Since ultrasound uses high-frequency sound waves to generate images, the gel helps in good sound wave transmission. Typically, ultrasound is safe as it does not have harmful rays and, hence, is used on pregnant women, too.
The difference between a normal external ultrasound and a PCOS scan is transvaginal. In a transvaginal ultrasound, the probe is inserted into the vagina and is more uncomfortable. However, this gives the best imaging of the reproductive organs for an accurate diagnosis. These images help your doctor manage the condition better. Although PCOS can be found in routine ultrasound, it is important to know the requirements to make a PCOS diagnosis, especially if you are being assessed for other conditions that may show the presence of this syndrome.
PCOS diagnosis is time-consuming and frustrating as other conditions show similar symptoms and hence have to be ruled out first. It is always a diagnosis of exclusion of certain related disorders - Transvaginal ultrasound provides valuable information, and you should work with the best sonographers with expertise to understand imaging and clinical definitions and diagnose PCOS confidently. Search for an ultrasound scan near me to find a lab that conducts PCOS scans.
Yes. Ultrasound can diagnose PCOS. However, to confirm the diagnosis, a combination of physical exams, blood tests and ultrasound is needed.
PCOS diagnosis is confirmed by the patient’s medical history, a blood test to check androgen levels, a physical examination and a pelvic ultrasound.
The best time for a PCOS scan is between 2 and 7 days of the menstrual cycle.
Irregular periods, hyperandrogenism and polycystic ovaries are the three diagnostic criteria for PCOS.
