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Orla Walsh, RD
Orla Walsh is a Registered Dietitian and Physiologist. Orla is the founder of Orla Walsh Nutrition, she is the former performance nutritionist to the Irish Olympic team and is regular contributor for the Irish Independent newspaper, RTE and Newstalk FM.

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I’m regularly asked the following questions about PCOS (PCOS meaning Polycystic ovary syndrome). As 1 in 10 women have PCOS (more than half of these women do not have any PCOS symptoms), there are plenty of people who need to learn more. So, I though I’d sum up the answers for you. I hope this helps!

How is PCOS Diagnosed?

A diagnosis can usually be made if other rare causes of the same symptoms have been ruled out.

To be diagnosed with PCOS (a PCOS test) you need to have 2 or 3 of the following.

  • Irregular periods, or no periods at all.
  • Increased hair growth on your face or body, or blood tests show you’ve higher levels of testosterone than usual.
  • An ultrasound scan shows you have polycystic ovaries.

You may not need to have an ultrasound scan or may not want one. Sometimes, a blood test for AMH levels is used (although that still remains a controversial area). AMH stands for anti-mullerian hormone and is secreted by granulosa cells of the follicles in the ovaries. AMH levels are significantly higher in women with PCOS, even after menopause.

What Is An Irregular Cycle?

Irregular menstrual cycles are defined as:

  • Between year 1 to 3 after the first period: cycles lasting < 21 or > 45 days
  • 3 years after the first period to perimenopause: cycles of < 21 or > 35 days or < 8 cycles per year
  • >1 year after the first period: a cycle lasting for > 90 days

Please note: ovulatory dysfunction can still occur with regular cycles and if wondering if an egg has been released from the ovary, serum progesterone levels can be measured in the week before expected period.

Also, the older you get, the more regular some women become.

Do I Have Cysts On My Ovaries?

The name should really have been changed! Polycystic ovaries contain a large number of harmless follicles. The follicles are underdeveloped sacs in which eggs develop.

When Should Periods Become Irregular?

After the first period, hormonal responses do not match adult patterns. Between year 1 and year 2 after the first period, about 1 in 2 menstrual cycles are 21 to 45 days long. Progesterone levels tend to be low.

The average adult menstrual cycle is 28 days but can range from 24 – 35 days. 2 years after the first period 80% of females can expect periods to fall into the adult pattern, with this number rising to about 95% by year 3. That said, cycles can remain irregular for the first 5 years after menstruation begins.

All this said, there is a but. The age at which a girl gets her first period can impact when she could expect a regularity with her cycle. Those who get their period before 12 can have a more reliable cycle than girls who get it later. If a female has an irregular period at age 15 years, 50% stay irregular by age of 18 years. This is one reason whey it’s important to talk to your GP if you have any concerns. Overall, irregular cycles (> 35 or < 21 days) that continue that continue that way for over 2 years are more likely to stay that way.

What Bloods Are Needed To Help With A Diagnosis?

PCOS bloods are as follows;

  • Testosterone is often thought of as a male hormone. But all women produce small amounts of it. Women with PCOS make slightly more testosterone than women without PCOS. This causes many of the symptoms of PCOS. A blood test to check total and free testosterone levels is needed to assess for hyperandrogenism (too much of them!). Total testosterone on its own can identify 20-30% of women with PCOS while free testosterone will identify 50-60%. In most adolescents, androgen levels reach adult ranges by 12-15 years so bloods become more reliable by then.
  • Sex hormone binding globulin (SHBG) is a protein in the blood. It binds to testosterone. SHBG levels appear low in PCOS.
  • If testosterone or free testosterone is not elevated, look at DHEAS. Your body needs DHEAS to produce androgens and oestrogen. Higher levels of DHEAS can be seen in PCOS.
  • Luteinising hormone might also be checked. Women with PCOS can have higher LH/FSH ratio.

Please note: It’s very difficult to reliably assess for hyperandrogenism in women on the combined pill (COCP) as the pill increases sex hormone binding globulin (SHBG) and reduces gonadotrophin-dependent androgen production. If required, you may be advised to stop the pill for at least 3 months and get your bloods done again.

  • All women with PCOS, regardless of age and BMI, should have their cholesterol levels checked. Their blood pressure levels need to be checked yearly too.
  • All women with PCOS, regardless of age and BMI, have an increased risk of impaired fasting glucose (sugar), impaired glucose (sugar) tolerance and type 2 diabetes. Insulin resistance affects 75% of lean women and 95% of those with a BMI > 25 kg/m2 with PCOS and is further exacerbated by excess weight. Blood sugar management should be assessed at diagnosis and repeated every 1-3 years. The 75g oral glucose tolerance test (OGTT) as the most accurate test to assess blood sugar management in PCOS, regardless of BMI. However, your doctor may choose to do HbA1c (average blood sugar over about 3 months) and fasting blood sugar levels. If pregnant, this test needs to be done at 24-28 weeks into the pregnancy.
  • Other tests that may be done indle Liver Function Tests (LFTS to test for ‘fatty liver’ and to monitor liver function before/ after starting medications and supplements), CRP (inflammation) and Thyroid Function Tests (TFTs).

PCOS treatment options are plentiful. However, everyone would beenfit from following a PCOS friendly diet. In my short course I discuss all things PCOS weight gain and PCOS weight loss.

What Are The Signs/Symptoms Of Higher Levels Of Androgens?

The presence of hirsutism alone should be considered predictive of high levels of androgens and PCOS in adults. Hirsutism is where women have thick, dark hair on their face, neck, chest, tummy, lower back, buttocks or thighs.

Female pattern hair loss and acne without hirsutism are relatively weak predictors of hyperandrogenism but can happen as a result of hyperandrogenism.

On a plus, women with PCOS may have more muscle mass than women without PCOS. However, females with PCOS may store more fat on their belly often dubbed the ‘PCOS belly’.

Does PCOS Go Away After The Menopause?

No. A diagnosis of PCOS is lifelong. Therefore, the dietary and lifestyle changes need to be followed for life.

Does Having PCOS Impact Sleep?

Women with PCOS have significantly higher risk of developing obstructive sleep apnea, regardless of BMI.

Symptoms include snoring in combination with waking unrefreshed from sleep, daytime sleepiness or fatigue. Speak to your GP if concerned. The Berlin questionnaire helps to screen for it, but diagnosis requires a sleep study.

Is Exercise Important in PCOS?

For the prevention of weight gain and maintenance of health, adults are advised to aim for a minimum of 150 to 300 minutes of moderate-intensity activities or 75 to 150 minutes of vigorous-intensity aerobic activity (cardio) per week plus muscle strengthening activities (e.g. resistance/flexibility) on 2 days per week.

For promotion of greater health benefits including modest weight loss and prevention of weight regain, the recommendation for cardio increases to at least 250 min/week of moderate-intensity activities or 150 min/week of vigorous intensities each week. The recommendations for strength training remain the same.

What Is Inositol?

Inositol belongs to the vitamin B complex group, and we can make it in our body. There are 9 different types. Myoinositol and D-chiro-inositol are important ones. Inositols are considered insulin sensitizers, which means they may help combat insulin resistance.

75% of lean women and 95% of women with bigger bodies with PCOS are thought to be insulin resistant. Inositol is often considered in women with PCOS as there is limited harm reported in taking it and potential for improvement in metabolic measures. It may help with ovulation, hirsutism or weight.

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