Polycystic ovary syndrome (PCOS) is a common cause of infertility, affecting from 8% to 20% of U.S. women of reproductive age, according to research. It is treatable but often difficult to diagnose, especially outside of the gynecologist or OB/GYN setting.

Diagnosing and treating PCOS early can help control symptoms and prevent long-term issues from developing, including diabetes, heart disease and uterine cancer.

“PCOS is more common than you may realize,” said Cornelia M. Poston, M.D., OB/GYN with Norton Women’s Care. “The key is early diagnosis, and that requires building understanding and trust between the patient and provider, particularly internists, who need to recognize the symptoms and develop a management plan.”

For internists and other front-line providers, focusing on two of the most common characteristics of PCOS is key to an early diagnosis.

Early signs of PCOS

PCOS is caused by an imbalance of hormones, resulting in small cysts growing on the ovaries. It mostly affects patients in their late teens and 20s.

PCOS is one of the most common causes of female infertility. Common symptoms can include:

• Irregular periods or no periods at all
• Infertility
• Facial hair (hirsutism)
• Thinning hair or hair loss on the head
• Weight gain
• Pelvic pain
• Acne or oily skin

Symptoms such as irregular or skipped menstrual periods, facial hair or weight gain often can be treated outside of the diagnostic criteria for PCOS. During a routine examination, an internist may not always ask about the regularity of menstrual cycles. With symptoms that mimic other conditions, patients often can go years without a PCOS diagnosis.

Bloodwork often can identify abnormalities, including thyroid issues, elevated cholesterol, increased blood glucose and elevated testosterone. An ultrasound may be used to detect ovarian cysts.

Keys to diagnosing PCOS

The most severe cases almost always are associated with heavy, missed or irregular periods and hirsutism.

Internists routinely should inquire about the patient’s menstrual cycles. Key questions would focus on the patient’s last period, monthly frequency and whether any cycles have gone longer than 35 days.

Hirsutism on the face or chest is a sign of high levels of androgens, male hormones that also are present in those assigned female at birth, along with acne and thinning hair on the scalp. An internist should keep in mind how shaving and plucking hide the development of hair and make diagnosis harder.

Being overweight can contribute to PCOS, so diet and exercise can help. Lifestyle changes may be included as well as medications to help control symptoms.

Because PCOS can have serious health consequences, issues surrounding menstrual cycles and hirsutism are triggers to coordinate with the patient’s gynecologist for additional care and treatment.