PCOS Diagnostic Profile

PCOS is the most common endocrine disorder in reproductive-aged women affecting more than 5 million women in the United States.² Guidelines recommend a diagnosis of PCOS if two of the three following criteria are met: androgen excess, ovulatory dysfunction, or polycystic ovaries.

Measurement of total or free testosterone should be done using liquid chromatography-mass spectrometry (LCMS) assays. Guidelines also recommend excluding thyroid disease (TSH), prolactin excess (prolactin), and nonclassical congenital adrenal hyperplasia (17-OH progesterone) before diagnosing PCOS. Additionally, women should potentially be evaluated to rule out pregnancy, hypothalamic amenorrhea (HA), primary ovarian insufficiency, androgen-secreting tumor, Cushing's syndrome and acromegaly depending on clinical presentation.^3,4

Once diagnosed, assessment and management of reproductive, metabolic and psychological features is vital to patient care. Many significant comorbidities are associated with PCOS, and additional testing for monitoring is recommended. Women with PCOS experience symptoms of androgen excess associated with PCOS, and additional testing for monitoring is recommended. Women with PCOS experience symptoms of androgen excess associated with menstrual abnormalities and infertility. Chronic anovulation experienced by patients with PCOS increases their risk of developing endometrial cancer. Women with PCOS are often overweight and are likely to suffer from insulin resistance, putting them at increased risk for developing type 2 diabetes mellitus and nonalcoholic steatohepatitis (NASH).^5-7 Lipid abnormalities, including decreased high-density lipoprotein cholesterol levels and elevated triglyceride levels, as well as impaired fibrinolysis, are seen in women with PCOS.^6,8 Cardiovascular disease is more prevalent, and women with PCOS have a significantly increased risk for myocardial infarction.^6,8