Polycystic Ovary Syndrome (PCOS) is the most common reproductive disorder in women. It is also one of the most common disorder to be misunderstood, overdiagnosed and inadequately treated. Syndrome, as such means a combination of several symptoms and signs. PCOS is a diagnosis based on the presence of excessive male pattern hair growth, history of irregular periods (rarely, periods may be regular) and the appearance of ovaries in a ultrasound. Each of the above three has several important and trivial issues that needs to be thoroughly looked into. Endocrinologists are the physicians who have adequate training in diagnosing and managing such hormonal conditions.
Excessive hair growth is often misunderstood by patients and doctors. Hirsutism is male pattern terminal hair growth that can be diagnosed by physical examination by a experienced physician. Commonest mistake is to diagnose it just based on inspection of face which needs to be avoided (because there are several regions in the body where androgen dependent hair growth may occur). To call it hirsutism there must be thick, terminal hair and not thin, vellus hair. There are hormonal tests that needs to be done to rule out certain other conditions associated with hirsutism and only then can a diagnosis of PCOS be made. Hence, PCOS is a diagnosis of made by excluding other similar disorders and not by a single USG showing polycystic ovary. Another important myth is that of polycystic ovaries. Normal ovaries in a regularly menstruating women have numerous developing follicles which gives polycystic appearance. There is a definite number and size of follicles to call it polycystic ovaries – which in majority of scans are not mentioned. Even then, 3 in 10 healthy women have truly polycystic ovaries and hence, presence of polycystic ovaries in USG does not mean having a PCOS. These mistakes are overlooked and hence PCOS is overdiagnosed by non-endocrinologists.
PCOS is basically a lifestyle disorder similar to diabetes and hypertension. It is caused by improper lifestyle added on to predisposing genetic and environmental conditions. Insulin resistance in the body leads on to increased male hormones, ovarian dysfunction and predisposes to cardiovascular risk like diabetes, hypertension and obesity. Importantly, it has influence on fertility and that is the reason why it must be properly diagnosed and treated.
Endocrinologist's role lies in making a proper diagnosis, looking for co-morbid conditions, diagnosing other mimicking disorders, treating menstrual irregularity, managing hirsutism and in helping women to conceive.