When women arrive in your office with any one or all of the following complaints from amenorrhea to excessive bleeding, difficulty losing weight, excessive hair growth and acne or infertility, it is an opportunity to change a woman’s life for the better. Many of these women have seen multiple providers, who more often than not aren’t able to provide a diagnosis or who may not be able to provide a comprehensive plan of care. Many women with PCOS have symptoms that impact their appearance, their self-esteem, sense of shame and guilt as well as fears of infertility.
Using the Rotterdam Criteria for diagnosis provides an objective starting point for evaluating women. A diagnosis of PCOS can be made if 2 out of the following 3 conditions are met: Signs of hyperandrogenism such as hirsuitism, acne, oligo or anovulaton and or polycystic ovaries on ultrasound while ruling out and excluding other causes of androgen excess including Non-classic Congenital Adrenal Hyperplasia (CAH), Androgen secreting tumors, or Cushings syndrome.
When considering Polycystic Ovarian Syndrome, it’s important to think of the cysts in the ovary as only 1 aspect of a complex endocrine disorder that includes insulin resistance, an increased risk of endometrial hyperplasia from increased circulating estrogen levels, and more infertility. With a diagnosis, treatment options can be offered to suppress androgens, correct insulin resistance and protect the endometrium. All throughout the evaluation and care, it’s also important to address and validate repeatedly that this condition is not the woman’s fault. No woman would ever choose to have increased hair growth, more acne and difficulty losing weight. All of these affect a woman’s self-esteem and many women wonder if they are causing this from their diet or perhaps lack of exercise.
In my talks at the upcoming Skin, Bones, Hearts and Private Parts continuing education meetings, I’ll be speaking about these important considerations and many others that can improve women’s quality of life when they have PCOS.
See Barb Dehn, RN, MS, NP, FAANP, NCMP speak in Nashville, Pensacola Beach, Orlando (October) in 2017.