PCOS is known as polycystic ovarian syndrome. This is a complicated, often misunderstood diagnosis and a diagnosis that is often given without thorough evaluation.
Patients who have PCOS often have irregular or no periods, extra accessory hair on their face, metabolic resistance, and cysts on their ovaries. People with PCOS can also struggle with extra weight and have trouble losing weight.
PCOS is a disorder that is not well researched. We have an idea of what symptoms may be consistent with PCOS, but there is no definitive lab test or definitive imaging to diagnose PCOS.
Many times the diagnosis of PCOS is a process of elimination. Providers rule out other causes of your symptoms and often land with a diagnosis of PCOS.
Labs can be completed to check for diabetes, thyroid dysfunction, and hormones. Imaging can be done to look for cysts on the ovaries or other causes of irregular periods.
There is no cure for PCOS. The goal of the provider is to manage the symptoms and meet the goals of the patient. Management of PCOS is based on your goals.
If the Goal Is Pregnancy
In order to achieve pregnancy, the patient needs to have regular periods. Labs will be completed to rule out causes of irregular periods and if there is anything that needs to be supplemented to help with that.
Ensuring regular periods will help increase the chances of regular ovulation.
Weight loss can often help regulate periods for patients if they have an elevated BMI.
We also need to ensure the patient does not have metabolic resistance due to PCOS like diabetes. If so, this can have an impact on fertility.
If supplementation and healthy lifestyle choices do not cause regular periods, or if regular periods return but no regular ovulation, it may be time to speak with a fertility specialist about conception.
If the Goal Is Regular Periods, but Not Pregnancy
Some patients do not want to be pregnant, but want to have a regular period.
This can be achieved by using a birth control method to regulate periods.
If the patient is a candidate for estrogen-containing birth control, this can be a great way to regulate periods and ensure that patients have a period each month.
Some patients just need a one-time progesterone challenge to bring back periods. This is where we use progesterone pills for 10 days to make a period come. For some patients, this reminds the uterus to do its job and periods return like normal. It doesn’t always work but it is a low-risk, short-term option to try.
If the Goal Is Managing Symptoms
It is important to list the symptoms that are most bothersome for you.
Periods can be managed with birth control or progesterone.
Facial hair can be managed with an antiandrogen medication or laser hair removal.
Insulin resistance can be addressed with medication to help break down sugar and can help with weight loss.
If the Goal Is to Have Information
This is the time for labs and imaging. We can collect labs to see if they are consistent with what we expect to see in patients with PCOS.
Imaging can look for pearl-like strings of ovarian cysts on the ovaries.
It can be empowering to know why the symptoms are occurring, even if you don’t want to do anything about it right now.
What to Know About PCOS Diagnosis
With PCOS, it is not required for you to have all of the symptoms or predicted lab and imaging values. Some patients have all the symptoms and all the positive values, while some people only have a few or one.
Management of suspected PCOS can still occur with or without labs and imaging. This leads to more equitable care regardless of your location or financial status.
It is important to find a provider you feel comfortable discussing all of your symptoms, concerns, and goals with to help manage your PCOS and related symptoms.
PCOS Care in Greensboro and Across North Carolina
If you have been told you may have PCOS or are struggling with irregular periods, unwanted facial hair, or difficulty with weight loss, Haven Health provides PCOS evaluation and management in Greensboro, North Carolina and by telehealth across the state.
Many patients receive a PCOS diagnosis without clear answers. Haven Health focuses on understanding your symptoms and your goals to create a personalized plan of care.
Patients from Greensboro, High Point, Jamestown, Oak Ridge, Summerfield, Kernersville, and surrounding Guilford County communities visit Haven Health for compassionate reproductive care.
If you live anywhere in Winston-Salem, Charlotte, Raleigh, Durham, Asheville, Wilmington, or anywhere in NC, you can meet with a provider virtually to discuss your symptoms and have any necessary labs completed at a lab near you.
Haven Health provides patient-centered, evidence-based reproductive care both in person and online across North Carolina.