Visual, hidden clues to PCOS aid diagnosis

OB/GYN News, March 1, 2003 by Nicholas Mulcahy

NEW YORK -- Polycystic ovarian syndrome is underrecognized but could be more widely diagnosed if clinicians were better attuned to its visual clues, including hirsutism, which many patients are effective in partially hiding, Dr. Geoffrey Redmond said.

"The typical visual signs of PCOS are overweight/obesity and androgenic skin and hair changes-namely acne, hirustism, and androgenic alopecia. However, not all patients with PCOS have all these signs, and hirsutism is often concealed," said Dr. Redmond, who is director of the Hormone Center of New York in New York City.

An estimated 10% of American women, including many women with PCOS, remove hair twice a week. Still, hirsutism is frequently detectable if the clinician looks and/or inquires closely enough, he said at a gynecology symposium sponsored by Symposia Medicus.

"Some women will only mask the hair growth with bleaching or will only remove facial and neck hair and not areas of body hair," he said.

Hirsutism may be especially helpful in diagnosing PCOS in women with slender or average body sizes. "Women with PCOS are usually overweight but not always. Slender women with PCOS have a milder form and are probably not at risk for metabolic complications such as diabetes. However, they usually have hirsutism and can benefit from diagnosis and treatment with antiandrogens," Dr. Redmond noted.

The antiandrogens used in the treatment of PCOS include spironolactone, described by Dr. Redmond as the "most generally useful antiandrogen."

In patients with PCOS and acne, identifying the patient's syndrome is necessary to effectively treat the acne. "If you only treat the acne and not the underlying androgenic disorder with antiandrogens, you will not have success with the acne in a patient with PCOS," he said.

The hair loss or alopecia associated with PCOS is also often unrecognized. "Androgenic alopecia has a unique pattern in women, compared with men. The hair thinning occurs behind the hairline, with the hairline remaining intact," he said.