IS IT POLYCYSTIC OVARIAN SYNDROME?

 

Dr Steven R. Goldstein is an Obgyn in Manhattan that has seen very young patients come in with their mothers and present with a diagnosis of Polycystic Ovarian Syndrome (PCOS). They are requesting a second opinion. If you have been told you have PCOS, then there is some information you should know.

 

PCOS affects roughly five to fifteen percent of women of reproductive age but many of the cases go undiagnosed. Many of those diagnosed are in their twenties or thirties. Here’s a bit of history on PCOS.

 

In 2003 there was The Rotterdam Criteria for the Diagnosis of PCOS, at that time the consensus was if a women had two of the following three characteristics she could be labeled as having PCOS. They were 1) irregular menses, 2) increased androgens (either in their blood or clinical manifestations), and 3) more than twelve follicles in their ovary on ultrasound.

 

Today, as the resolution of transvaginal ultrasound has increased, as many as 50% of women will have more than twelve follicles in their ovary! And many young women will be having slight irregularity to their menses as their cycle “matures.” Their menstrual cycle is still slightly irregular because of the fact that the hypothalamic-pituitary-ovarian axis has not yet matured. And if patients are extremely young, they may have what Dr Goldstein refers to as “multicystic ovaries” instead of polycystic ovaries.

 

Typically, the women who were thought to have PCOS would be obese, have male pattern hair growth (especially on the chin), and bloodwork showed increased androgens (testosterone and an entity know as DHEA-S). These recent patients seen by Dr Goldstein who were diagnosed by other physicians to have PCOS were 1) not obese, 2) had no evidence of increased androgens, either clinically or in their blood, and 3) were extremely healthy.

 

It has been Dr Goldstein’s experience that the overwhelming majority of such patients, as they get into their mid- and later twenties, ultimately have very normal menstrual cycles, normal fertility, and no increased risk of insulin resistance or diabetes. 

 

Upon examination, none of these recent cases truly had PCOS itself. What they had was not unusual for late adolescence (women in their teens and even early twenties).  The problem is someone performed an ultrasound and they had multiple small follicles in their ovary, and thus, were told they had polycystic ovarian syndrome. 

 

In the opinion of Dr Goldstein, a Gynecologist in Manhattan, it is important as to how the follicles are arranged in the ovary. In the original description of polycystic ovarian syndrome, the follicles were all very peripheral and often were referred to as a “string of pearls,” the appearance of small follicles around the edge of an ovary.  This is what points to Polycystic Ovarian Syndrome (PCOS).

 

Women cannot be diagnosed as having PCOS with just an increased randomly distributed number of follicles. There must be the string of pearls pattern.

 

If you have been told that you have Polycystic Ovarian Syndrome (PCOS) and would like a second opinion, schedule a consultation with Dr Steven R. Goldstein MD, a leading Manhattan Obgyn