Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects how a woman’s ovaries function. There is a common misconception that irregular periods are always present with PCOS. However, it is possible to have PCOS even with regular menstrual cycles.
Understanding PCOS Beyond Period Regularity
PCOS is a complex condition diagnosed by multiple factors, not solely by menstrual irregularity. While irregular periods are common, they are not always present. Regular menstrual cycles do not guarantee regular ovulation, and ovulatory dysfunction is a recognized component of PCOS.
The diagnostic framework, widely known as the Rotterdam Criteria, requires the presence of at least two out of three specific criteria to diagnose PCOS: oligo-ovulation or anovulation (infrequent or absent ovulation), clinical or biochemical signs of hyperandrogenism (excess male hormones), and polycystic ovaries on ultrasound.
Other Indicators of PCOS
Even with regular periods, other signs and symptoms of PCOS can be present. One significant indicator is hyperandrogenism, which refers to high levels of “male” hormones in the body. This can manifest as hirsutism, which is excessive hair growth typically on the face, chest, back, or buttocks, affecting up to 70% of individuals with PCOS. Severe acne, often continuing beyond teenage years and difficult to treat, is another common symptom. Androgenic alopecia, or male-pattern baldness, can also occur.
Another indicator is the presence of polycystic ovaries on an ultrasound. “Polycystic” in this context refers to numerous small follicles, typically 2-9 mm in size, around the edge of the ovary, not painful cysts. These follicles are underdeveloped sacs where eggs mature, but in PCOS, they often fail to release an egg, preventing ovulation. Related metabolic issues like insulin resistance and weight gain are also frequently associated with PCOS.
Diagnosing PCOS With Regular Periods
When a person with regular periods presents with suspected PCOS symptoms, healthcare providers conduct a thorough evaluation. A diagnosis of PCOS can be established if clinical or biochemical hyperandrogenism and/or polycystic ovarian morphology are present, even with regular periods.
Diagnostic tests typically involve blood tests to assess hormone levels, including androgen levels such as testosterone, and sometimes glucose tolerance tests to check for insulin resistance. A pelvic ultrasound is also performed to visualize the ovaries and count the number of follicles, with 12 or more follicles measuring 2-9 mm in diameter in at least one ovary, or an ovarian volume greater than 10 mL, often indicating polycystic ovaries. A comprehensive medical evaluation helps differentiate PCOS from other conditions that might present with similar symptoms.