Question for Betty.

If you don't get your period for months and know you're not pregnant, do you automatically have PCOS? What determines that you have PCOS? Does the SHCC offer ultrasounds of the ovaries?

Betty's Answer.

You have picked a very popular topic, Polycystic ovary syndrome (PCOS). Missed periods do not automatically indicate that you have PCOS. There are many causes for missed periods.

First of all you want to be sure that you are not pregnant if you have missed periods and are sexually active.  Menstrual cycle disorders can also be caused by medications (including herbs, and vitamins), recent stress (like college), environmental changes (like living away from home), changes in weight, diet, exercise patterns, changes in hormones and sometimes thyroid problems.

See your health care provider if you miss more than three menstrual periods (either consecutively or over the course of a year), for evaluation.  The evaluation will include a complete history, physical and often labs for hormone levels, thyroid and metabolic testing. 

Polycystic ovary syndrome (PCOS) is a chronic condition that cause infrequent periods and an excess of androgens (male hormones). Classic PCOS includes irregular menstrual periods, hirsutism, obesity, and classic ovarian changes.  Some women have normal cycles which become irregular if the woman becomes overweight. Women with PCOS usually have fewer than six to eight menstrual periods per year. If ovulation does not occur, the lining of the uterus does not uniformly shed and regrow as in a normal menstrual cycle.  It can become thicker and shed irregularly, which can cause heavy and/or prolonged bleeding.

The National Institutes of Health (1990 PCOS Conference) proposes that a woman must have all of the following to be diagnosed with PCOS:

1. Irregular menstrual periods caused by anovulation or irregular ovulation.

2. Evidence of elevated androgen levels.  This can be based on signs (excess hair growth, acne, or male pattern balding) or blood tests (high androgen levels).

3.  No other cause of elevated androgen levels or irregular periods, such as congenital adrenal hyperplasia, androgen-secreting tumors, or hyperprolactinemia.

Blood tests usually recommended are: pregnancy, prolactin level, TSH (thyroid stimulating hormone), and FSH (follicle stimulating hormone).

If PCOS is confirmed, blood tests for glucose, cholesterol, testosterone, and DHEA-S may be recommended.

The Androgen Excess Society proposes that the definition should include those with polycystic ovaries, hyperandrogenism and apparently normal ovulation (and menses).   

If you think you may have PCOS and/or need evaluation for irregular menses please contact your health care provider or make an appointment with the SHCC for information. As per your final question; the SHCC can refer you for an ovarian ultrasound, if this is needed.