As part of September being Polycystic Ovarian Syndrome (POCS) Awareness Month, in this article we will be discussing the patient profile of a female suffering from this condition.  

POCS is a hormonal disorder commonly found among women of reproductive age.  It can cause patients to have irregular or absent menstrual periods, unwanted facial hair, acne, and even diabetes mellitus. As part of creating awareness, below outlines the profile of a patient with PCOS based on up-to-date information about the disease. (Per HIPAA regulations, all of the patient information below is fictional and is not intended to portray any real person’s medical information.) 

So, what does the profile of a patient with POCS look like? 

Name: A. Doe 

Age: Late teen years to young adult  

Gender: Female 

Reason to visit a doctor: She reports having heavy and irregular periods with pelvic pain, inexplicable weight gain, and recent acne problems. She also mentions being concerned about not being able to get pregnant in the future due to her irregular periods. 

Other common symptoms A. Doe’s doctor might ask her about: 

• Hirsutism 
• Missed periods 
• Family history of POCS 
• Fatigue 
• Mood swings 

Diagnostic tests: There is not one test to diagnose a patient with POCS. The doctor will ask questions about menstrual cycle, lifestyle, and other body changes or symptoms. Such questions can be related to family history of POCS and any problems getting pregnant. 

Physical exams may be performed: 

• Body Mass Index (BMI) 
• Skin-checking for any discoloration, acne, or hirsutism 
• Pelvic exam 
• Sonogram 

Hormone levels tested:

Hormone	Normal range	POCS
LH and FSH*	5-20 mlU/ml	Elevated LH to FSH ratio or a ratio of 3:1
Estrogen	25-75 pg/ml	Within normal levels
Progesterone	14 ng/ml	Low
Testosterone	Total testosterone  (6.0-86 ng/dl.)  Free testosterone (0.7-3.6 pg/ml)	Elevated in both forms of  testosterone
DHEAS*	35-430 ug/dl	>200 ug/dl
Prolactin	<25 ng/ml	Elevated (25-40 ng/ml)
Androstenedione	0.7 ­-3.1 ng/ml	Elevated
TSH*	0.4-3.8 uIU/ml	Within normal levels

Other hormones levels that are closely monitored are cholesterol, insulin, glucose, LDL, and HDL.

Final diagnosis: After the interviews and exams, the physician can give a diagnosis of POCS if the patient shows two of the following three symptoms per the 2003 Rotterdam criteria for diagnosis:

Hyperandrogenism

Ovulatory dysfunction

Polycystic ovaries

A patient diagnosed with POCS should be screened for metabolic abnormalities such as type 2 diabetes mellitus and hypertension, regardless of BMI according to the 2003 Rotterdam criteria for diagnosis.

Complications:  

• The main concerns are hormonal problems related to insulin, androgens, and progesterone levels. Thus, patients are at risk of developing diabetes and heart disease. 
• Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen. Which is a risk factor for endometrial cancer. 
• Patient can develop multiple metabolic defects
• Patients can also suffer from or develop anxiety and depression. 
• Other complications such as sleep apnea and fatty liver disease

Treatment and medications: There is no cure for POCS. Treatment is provided in order to help with the symptoms such as A. Doe’s pelvic pain, for example. A combination of birth control pills to help with hormone balance. Medication to help with fertility such as clomiphene and letrozole.  In this case, the patient is concerned about not being able to get pregnant in the future, which the physician will need to take into account. Patients who are suffering from high glucose levels are recommended to take Metformin, an oral diabetes medicine.

It is important to mention that due to variable presentation among POCS patients, treatment is highly individualized.

Lifestyle improvements:  

The physician would recommend A. Doe to have an active lifestyle by exercising regularly and to avoid sugary foods in order to lose excess weight and regulate blood glucose levels. Medication such as Metformin aid in regulating blood glucose levels.

Sources: 

Overview. PCOS Awareness Association. (n.d.). Retrieved August 19, 2020, from https://www.pcosaa.org/pcosinfo 

Johnson, T. (2019, September 27). Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, Tests, and Treatment. Retrieved August 20, 2020, from https://www.webmd.com/women/what-is-pcos 

Polycystic ovary syndrome (PCOS). (2017, August 29). Retrieved August 21, 2020, from https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443 

Polycystic Ovary Syndrome (PCOS): How Is It Diagnosed? (n.d.). Retrieved August 21, 2020, from https://www.endocrineweb.com/conditions/polycystic-ovary-syndrome-pcos/polycystic-ovary-syndrome-pcos-how-it-diagnosed 

Polycystic ovary syndrome (PCOS). (2017, August 29). Retrieved August 21, 2020, from https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439 

Sterling, E. (2011). Hormone Levels and PCOS. Retrieved August 26, 2020, from https://www.contemporaryobgyn.net/view/hormone-levels-and-pcos

Williams T, Mortada R, Porter S. Diagnosis and Treatment of Polycystic Ovary Syndrome. Am Fam Physician. 2016;94(2):106-113.