Examination for Detecting PCOS

PCOS is often detected when women undergo fertility programs (in cases of infertility), resulting in delayed treatment. Although pregnancy can occur after proper treatment, it is advisable to conduct examinations early, during adolescence, especially if there are symptoms and signs of PCOS as mentioned above. This is particularly important for women experiencing obesity, menstrual disorders, and those with a genetic or familial history of PCOS.

Examinations to Detect PCOS:
1. Radiological Examination
   - Ovarian ultrasound is usually performed transvaginally to assess ovarian morphology. Abdominal ultrasound can be done on adolescent girls or women who are not sexually active. According to the Rotterdam criteria, polycystic ovaries are identified by the presence of 12 or more follicles with a diameter of 2–9 mm in each ovary. This condition may be accompanied by an increased ovarian volume of over 10 ml. CT Scan and MRI are conducted to examine the adrenal glands and ovaries. MRI is the best modality for examining ovarian morphology in obese women where the ovarian morphology is not clearly visible via transvaginal ultrasound.

2. Hormonal Examination
   - Androgen Hormone (Testosterone): Hyperandrogenism is indicated by elevated circulating androgen levels. Free testosterone or free androgen index (FAI) is more commonly used in diagnosing hyperandrogenism. An FAI value above 5% indicates hyperandrogenism.
   - FSH, LH, Prolactin, Estradiol, and Progesterone Hormones: Patients with PCOS have increased prolactin levels (usually above 25 mg/dL). Hyperprolactinemia is checked during fasting.
   - Anti-Mullerian Hormone: Anti-Mullerian hormone (AMH) levels are reported to be 2-3 times higher in PCOS patients compared to the normal population. The AMH threshold for predicting PCOS is 4.45 ng/ml.

3. Blood Chemistry Examination
   - Lipid Panel (Total Cholesterol/Triglycerides/LDL/HDL):
   - Fasting Blood Sugar/Post Prandial/HbA1c/Insulin: PCOS patients often suffer from obesity caused by type 2 diabetes and dyslipidemia.

Management of PCOS

The management of polycystic ovary syndrome (PCOS) consists of three parts:

1. Lifestyle Modification
   - Lifestyle modifications include weight loss and a calorie-restricted diet high in fiber. Consumption of carbohydrates, saturated fats, and trans fats should be reduced, while intake of omega-3 and omega-9 fatty acids should be increased. Physical activity is recommended with moderate intensity for at least 30 minutes 5 times a week, or high intensity for at least 20 minutes 3 times a week, or a combination of both.

2. Pharmacological Management
   - Clomiphene: First-line therapy for ovulation induction in patients with anovulation.
   - Combined Oral Contraceptive Pills: Used to induce regular menstruation. Oral contraceptives not only prevent ovarian androgen production but also increase sex hormone-binding globulin (SHBG) production.
   - Metformin and Pioglitazone: Used to address insulin resistance.
   - Spironolactone and Finasteride: Antiandrogen drugs.
   - Letrozole: An aromatase inhibitor used to induce ovulation.

3. Surgical Treatment
   - Surgical therapy for polycystic ovary syndrome (PCOS) aims to restore ovulation. Various laparoscopic methods including electrocautery, laser drilling, and multiple biopsies can be considered for women with PCOS resistant to clomiphene.

As explained above, PCOS is a disease that can cause infertility in women of reproductive age. Therefore, it is crucial to diagnose PCOS early in adolescent women to receive appropriate treatment, maintain reproductive health, and prevent infertility.

Author: Dr. Syamsul Andi Hakim (Medical Consultant, PRAMITA Laboratory, Sumarecon Branch, Bekasi)

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