Do I have Polycystic Ovarian Syndrome (PCOS)?
If you have a period, you've probably heard the term PCOS thrown around many times before. When one in ten folks who menstruate can expect to be diagnosed with PCOS at some point in their lives (or already have been), it makes sense that it comes up in conversations around menstrual health among friends and family, or in your researching possibly symptoms online.
PCOS is a metabolic and hormonal health condition that can be somewhat challenging to get a proper diagnosis for. There are many other hormonal conditions with overlapping or similar presentation and it can sometimes be frustrating to get your hormonal symptoms taken seriously to initiate a proper workup/assessment. PCOS can have extensive impacts on your menstrual cycles and periods, and when untreated, it can also lead to increased risk of other negative health outcomes associated with high cholesterol levels, insulin resistance, and long term risk for type 2 diabetes.
This is why confirming a diagnosis and going through a proper assessment with a healthcare practitioner you trust is so important. The sooner you are able to identify and treat PCOS, the sooner you can engage in a treatment focused on health promotion and disease prevention - so you can be the best and most balanced version of yourself, now and in the future!
Let's break down how to know if you might have PCOS. From an individual perspective, you may begin to notice changes to your menstrual cycle and hormones such as:
Irregular menstrual cycles - typically ones that stretch longer than 35 days apart
Increased body or facial hair growth
Increased hair thinning along the temples or hairline
Increased acne
While these changes immediately make me as a practitioner curious about PCOS, these aren't enough on their own to confirm diagnosis. Currently, the most commonly accepted diagnostic criteria used by healthcare practitioners is called the Rotterdam Criteria. As part of this criteria, and individual needs to have any TWO of the THREE criteria to formally be diagnosed with PCOS:
Clinical or laboratory signs of elevated androgens - this means physical symptoms (acne, hair growth/loss) or lab work (high DHEAs, androstenedione, or testosterone) via blood test. You can have one or both, and still check off this box.
Polycystic ovaries on ultrasound - a side note on this one: while the condition is called PCOS, you don't actually have to have polycystic ovaries on ultrasound (PCO) to garner a diagnosis! You can in fact have normal ovarian imaging, no cysts on your ovaries and STILL have PCOS. This is why an ultrasound by itself is not considered diagnostic. I’ve you’ve been diagnosed via ultrasound alone in the past, we may want to do some deeper investigation.
Irregular or anovulatory cycles - this typically means going 35 days or longer between periods, but it can sometimes be a bit more complex that that. Anovulatory cycles (ones in which you're not ovulating) can also sometimes show up as irregular spotting/breakthrough bleeding all cycle long OR very short cycles OR completely absent periods all together. Learning how to track for and confirm ovulation (or a lack thereof) is essential here
If you're unsure or unclear of any of these 3 criteria, but think you may have PCOS, working with a naturopathic doctor with a focus on hormonal health is a great next step! When I suspect PCOS with my patients, we work through a careful intake and assessment process together - referring out for an ultrasound, requisitioning blood work for androgen levels, and educating on how to track for ovulation signs.
There is so much evidence to support the use of nutrition, supplementation, and lifestyle support in the management of PCOS, though the first step in the process is an accurate and complete assessment process. For women seeking a personalized, natural approach to PCOS, consulting a naturopathic doctor with a special interest in women’s health can be a transformative step to a healthier future. If you're interested in chatting more about whether or not you have PCOS and getting started on the path to naturopathic treatment, I offer free 15 minute meet and greet appointments to discuss your health goals. I look forward to being a hormone detective with you!
Dr. Jennah Miller, ND is a naturopathic doctor based in Toronto and Halifax, with a passion for menstrual health and hormones. She works with women and people with periods in co-creating supportive health practice that integrate seamlessly with their lifestyle and goals. Jennah has a passion for finding solutions to PMS, PCOS, period pain, and fertility for folks of all ages.