PCOS has become the “go-to” diagnosis for women with a few pounds to shed, some irregular periods, and mild hirsutism (aka: excess hair in unwanted places). Although we are happy to see that PCOS has made it to “prime-time” there are definitely problems related to over-diagnosing PCOS.
For one, if you don’t have PCOS, then you may miss the boat on exactly why you are having issues. This can delay recovery if you don’t get the right treatment you need and lead you astray from feeling and looking better and fixing your hormones. Second, being labeled as having PCOS when you don’t creates a lot of unnecessary worry and can impact treatment and medication choices that may not be right for you. In many cases there is actually no need for intervention because some situations will heal by themselves.
So, what else could be going on?
There are a lot of reasons to receive a PCOS diagnosis when you actually have something else. We call these the great PCOS mimickers . . .
A pelvic ultrasound shows “polycystic” ovaries
This alone doesn’t mean you have PCOS. Seeing lots of tiny follicles on ultrasound is a common finding, particularly in younger women. This only means that you have developing eggs. The flip side is also true. NOT having polycystic appearing ovaries on ultrasound doesn’t necessarily mean you DON’T have PCOS.
What’s the fix? Leave this alone!
You stopped the pill and your periods aren’t normal
Being on the birth control pill can temporarily mess up your hormone and insulin balance which can give the appearance of PCOS. The pill can lead to mild levels of insulin resistance, a common sub-type of PCOS. Women may even have high androgen levels detected on blood testing after the pill is stopped. This can happen because free androgen levels are suppressed while you are on the pill, and will rebound and temporarily rise once you stop it. It could take up to 1-2 years for androgen levels to return to normal.
What’s the fix? Often nutrients are depleted after long term pill use. Your liver may need a boost to clear out excessive hormone accumulation. But for most of you your body will eventually return to baseline – meaning back to how you were before taking birth control pills.
Teens with irregular periods, polycystic ovaries, and high androgens
Beware that in teenagers, seeing tons of follicles on ultrasound is a VERY common finding and does NOT necessarily mean you have PCOS. In fact many teens have symptoms of PCOS that will typically resolve on their own within 3 to 5 years after the start of getting periods.
What’s the fix? Unless you are really suffering with terrible symptoms, your hormones will regulate on their own and get balanced with time. Most girls need 3 years to settle into a normal period, so most experts discourage diagnosing PCOS sooner than 3 years after the onset of periods. That being said, if your teenage lifestyle habits stink (not eating well, not sleeping enough, not exercising enough and being uber stressed) then please work on these. It can only help you!
No period due to hypothalamus problems
If your brain is not giving your ovary the correct signals, you may not get your period and in certain cases, you will also have mild increases in your androgen levels. The key here is to correctly interpret your pituitary hormone levels on blood testing. If your LH (luteinizing hormone) and FSH (follicle stimulating hormone) levels are low, then you have a case of hypothalamic amenorrhea causing hormone issues.
What’s the fix? There are many reasons why this could be happening. Causes range from excessive emotional or physical stress, extremes of body weight, eating disorders, certain medications, psychological issues, and over-exercising, particularly in professional athletes. You need to address the root cause. In rare cases this could be a primary brain issue so you must check with your doctor for a full evaluation.
irregular periods and nipple discharge from high prolactin
Prolactin is a hormone made by the pituitary gland and is important for breast milk production and breastfeeding. Too much prolactin, leads to irregular periods and nipple discharge. PCOS can similarly trigger increases in prolactin levels so it’s important to check a brain MRI for benign pituitary tumors called prolactinomas.
What’s the fix? There are medications to shrink the tumors and restore normal prolactin levels. Also beware of certain medications (like antidepressants, anti seizure drugs and other psychotropic meds) that can lead to high prolactin levels.
more pcos mimickers
These PCOS mimickers need more formal medical assessment . . .
When there is either too little thyroid hormone (hypothyroidism) or too much (hyperthyroidism), many body functions can be thrown into chaos, leading to symptoms that are strikingly similar to PCOS. These can include irregular periods, unexplained changes in weight, and hair loss. A simple blood test to evaluate the TSH, T3 and T4 levels can help make the diagnosis.
Congenital Adrenal Hyperplasia (CAH)
This is a genetic disorder that causes the adrenal glands to make too little cortisol. Women can experience irregular periods, excessive hair growth (hirsutism), and no periods. Unlike PCOS, a doctor can diagnose CAH with a genetic test.
This is a disease that causes too much cortisol. It is typically caused by a benign tumor in the pituitary that over-stimulates the adrenal gland to make too much cortisol and androgens. Cushing’s syndrome can look very similar to PCOS. Symptoms include weight gain, hirsutism, and occasionally irregular periods.
The bottom line is what appears to be PCOS, may not be!
Work with a provider who specializes in diagnosing and treating hormone imbalance issues to get you on the right track. If you do have PCOS please check out our 6-week program. If you don’t have PCOS and your doctor doesn’t know why you have hormone imbalance issues consider using our program to restore your hormone health.