PCOS: Diagnosing the Commonly Undiagnosed

By Raia Hamad

At the age of 20, ‘Posh Spice’ Victoria Beckham was diagnosed with the most common endocrine disorder in women of reproductive age. That endocrine disorder is called Polycystic Ovary Syndrome (PCOS) and it affects 5-10% of women of reproductive age (Knockenhaur et al, 1998). Although it is believed to be immensely under-diagnosed, it is a leading cause of infertility/subfertility. It plagues around 48 million women worldwide and often times this is due to a genetic predisposition — Approximately 50 genes have demonstrated association with PCOS although none are causative of PCOS pathogenesis (Coleman, Tsongalis, 2009). Some of the common symptoms associated with PCOS are amenorrhea (absence of menses), hirsutism (Excess hair on upper lip, midline of lower abdomen, face, etc.), obesity, acne, polycystic appearance of enlarged ovaries, and heavy, painful periods (Azziz et al, 2004).

Image source: http://www.pcosaa.org/

Women with PCOS exhibit an increased level of circulating androgens produced by the theca cells, especially testosterone, and low levels of estrogens. Theca cells are the ovarian androgen-producing cells that are associated only with developing ovarian follicles (Magoffin, 2005). Normally the androgens that women do produce by theca cells are converted to estrogens in the follicular cells very rapidly. But in the absence of estrogen, you have this buildup of androgens that results to follicular arrest and atresia.  Without the increase of estrogen and progesterone, there is no feedback to the pituitary to trigger the luteinizing hormone surge that is required for ovulation (Balen, 2004). Other endometrial abnormalities include implantation defects, endometriosis and endometrial cancer.

Despite the alarming symptoms and repercussions, PCOS is commonly under-diagnosed due to several reasons: (1) The widespread use of birth control pills often mask some of the symptoms and makes it difficult for women to get properly diagnosed. This is especially true for the women who have been on birth control pills since their teenaged years. (2) Many women are ashamed of the various symptoms associated with PCOS and do not inform their physicians about what they’re experiencing. This results in women not being able to recognize that the different symptoms are the outcome of only one condition. (3) To exacerbate the issue, many doctors lack a solid understanding of PCOS and rationalize their patients’ PCOS associated symptoms as a result of lifestyle factors such as stress or weight gain rather than PCOS (Boss et al 2012). (4) Many of the associated symptoms affect the outward appearance of women and “patients and doctors alike do not consider aspects of our appearance to be important enough to address…As we all know, our appearance does affect our over all sense of well-being” (McCormick, 2013).

Doctors often address symptoms as being isolated from one another rather than address all of the symptoms through a holistic approach. PCOS diagnosis largely depends on symptomatology since we currently lack an absolute test for PCOS. As a result of these arising issues, a consensus was reached in 2003 that current PCOS diagnosis requires 2 of the following 3 symptoms: Polycystic ovaries detected using ultra sound, elevated levels of androgens in serum such as there being too much testosterone in circulation, and amenorrhea or oligomenorrhea (9 or less menses per year) (Barth, Yasmin & Balen, 2007). 50-70% of PCOS patients are affected by metabolic disorders such as insulin resistance and hyperinsulinemia, central obesity, and dyslipidemia (high triglycerides and low HDL-cholesterol) while 10-20% experience hypertension (Fingert et al, 2009). Recognizing and treating PCOS as early as possible is key since these clinical conditions put adolescents at risk of struggling with low-self esteem, depression and an increased likelihood of ultimately developing eating disorders. If left untreated, women are at an increased risk of cardiovascular disease and infertility in later years.  PCOS is different from person to person, which is why it’s imperative that one take an active role in their own health – Continue to confront the struggles and hardships with strength and don’t stop until you find a doctor that will listen to your difficulties and willfully address your issues.  

About the Author

Our blogger, Raia Hamad, is currently a student at the University of Illinois at Urbana-Champaign studying Molecular and Cellular Biology and Biological Anthropology - the realms that awaken her strongest passions. She also enjoys distance running and is enthusiastic about encouraging young women to pursue their interest in STEM.

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