Polycystic Ovary Syndrome, referred to as PCOS, is the most prevalent endocrine condition that impacts women of childbearing age. Yet it remains underrecognised and often misunderstood.
How common is it, really
There are different statistics quoted for prevalence worldwide, but it is safe to assume that around 10% of women worldwide are impacted by the condition, and many more are potentially undiagnosed. There is a range of symptoms that women with PCOS can present with, and the severity of these exists on a spectrum.
Because of the heterogeneity of the condition (i.e. there is no clear or distinct list of symptoms that all patients present with) it can be hard to diagnose. Ethnicity, age, weight and other factors impact the presentation and treatment of PCOS, making it more difficult for practitioners, healthcare professionals or even individuals to navigate. It leaves many women being undiagnosed, incorrectly diagnosed, or receiving delayed or unsatisfactory treatment.
Of women worldwide are impacted by PCOS, with many more potentially undiagnosed.
Of people with PCOS are affected by hyperandrogenism, according to the 2023 guidelines.
More than a fertility problem
For some time, PCOS has been regarded as a reproductive and fertility problem. But as the research in the field is growing, there is a growing understanding of the multitude of challenges that women with the condition face. The list of concerns include, but are not limited to, gynaecological, metabolic, psychological, dermatological, reproductive and cardiovascular issues.
It's important that the condition acquires more recognition so that more funding is acquired to research the pathophysiology and the true impact of it on everyday women. As it stands, the reason some women have this condition and not others has not been fully determined, but there is an understanding that it could be a combination of genetics, metabolism and environmental factors.
The 2023 International Evidence-Based Guidelines
In 2023, a group of over 1000 healthcare professionals, researchers and academics helped create the International Evidence-Based Guideline for assessment and management of PCOS. This guideline was created to provide a more standardised and universal approach to diagnosing and managing PCOS, and to overall help improve the lives of people with PCOS worldwide, using best practice and evidence.
Research note: Guided by the Rotterdam criteria, the guidelines lay out three clear features that should exist to qualify as having the condition: ovulatory dysfunction, hyperandrogenism, and polycystic ovaries.
1. Ovulatory dysfunction
A key feature of PCOS is ovulatory dysfunction, which is often reflected by irregular or absent menstrual cycles. The guidelines say that a menstrual cycle that is either less than 21 days or longer than 35 days is categorised as irregular. If this is the case, or if menses is absent altogether, then this should lead to further investigation of the cause.
It should be noted that these conditions apply to women who have had their menstrual cycle for over three years. Different conditions apply to adolescents who may experience irregularity as a normal part of puberty. Many women who come off the pill will also experience irregularity, so there are always exceptions to the rules.
2. Hyperandrogenism
Another diagnostic feature of PCOS is hyperandrogenism, which means an abnormally high amount of male sex hormones, like testosterone. According to the guidelines, this impacts 60% to 100% of people with the condition.
There are key visible features of excess androgens that can be used to assess whether someone has hyperandrogenism. If these aren't visible, blood tests can be conducted to determine the ranges of these hormones. The clinical features of excess androgens are known to greatly impact the quality of life of people suffering with PCOS, and hirsutism is considered the greatest predictor of PCOS.
When determining hyperandrogenism biochemically, there are a lot of markers that can be tested for, but the guidelines highlighted that free testosterone has the greatest specificity to diagnose hyperandrogenism.
3. Polycystic ovaries
As the name of the condition suggests, polycystic ovaries is a key feature for diagnosing PCOS. However it is not the sole feature, nor is it always necessary to detect to diagnose someone as having PCOS. Contrary to what the name suggests, the cysts found in the ovary are actually follicles that have not been released to form an egg. After some time these accumulate in the ovary and can disrupt hormone levels and therefore the menstrual cycle.
An ultrasound is required to detect polycystic ovaries. To diagnose PCOS, this isn't required in patients who have hyperandrogenism and ovulatory dysfunction, but should be conducted in patients that only present with one of the above. To diagnose PCOS, the ultrasound should detect 12 or more follicles on the ovary and a volume equal to or greater than 10mL.
Throughout life there are periods when the follicle count in the ovaries will vary. Namely, it's common for women to have more follicles present on their ovaries during adolescence.
Greater recognition of PCOS is not just a medical necessity but a crucial step towards supporting the countless women who navigate the challenges of this condition daily.
The bigger picture
Polycystic Ovary Syndrome is a multifaceted endocrine disorder that affects a significant portion of women of childbearing age, yet it remains underrecognised and often misunderstood. The recently established International Evidence-Based Guidelines represent a pivotal step in addressing the challenges faced by those with PCOS. By providing clear diagnostic criteria based on the Rotterdam criteria, these guidelines aim to foster better recognition and management of PCOS, ultimately improving the quality of life for affected individuals.
Worth knowing: By advancing knowledge and advocating for effective solutions, we can collectively work towards improving the lives of those affected by PCOS and fostering a more informed and empathetic approach to women's health.
References & Further Reading
- Williams, S., Sheffield, D., & Knibb, R. C. (2018). The Polycystic Ovary Syndrome Quality of Life scale (PCOSQOL): Development and preliminary validation. Health Psychology Open, 5(2), 205510291878819.
- Behboodi Moghadam, Z., Fereidooni, B., Saffari, M., & Montazeri, A. (2018). Measures of health-related quality of life in PCOS women: a systematic review. International Journal of Women's Health, Volume 10(1), 397–408.
- Teede, H., Mousa, A., Thien Tay, C., Laven, J., Dokras, A., Moran, L., & Costello, M. (2023). International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2023. Monash University. (Original work published 2018)
