PCOS Overdiagnosis? Why More Women Are Being Mislabelled
"Are expanding disease definitions unnecessarily labelling women with polycystic ovary syndrome? Experts raise concerns about overdiagnosis and the potential harms of labeling women, particularly younger women and those with milder symptoms."
Polycystic Ovary Syndrome (PCOS) stands as the most frequently diagnosed endocrine disorder among women of reproductive age, impacting fertility, reproductive health, metabolic function, cardiovascular health, and psychosocial well-being. Characterized by symptoms such as anovulation, irregular menstruation, ovaries appearing polycystic, and signs of androgen excess, PCOS manifests diversely, influenced by weight, ethnicity, and environmental factors. The severity of these symptoms varies significantly among individuals.
Over the years, the diagnostic criteria for PCOS have broadened, leading to an increase in the number of women diagnosed. This expansion has sparked concerns about potential overdiagnosis and unnecessary disease labeling, prompting a critical examination of the evidence and uncertainties surrounding PCOS diagnosis.
Originally identified in 1935 through a case series of seven women experiencing amenorrhea and infertility linked to multiple ovarian cysts, the diagnostic landscape of PCOS has evolved. Today, three distinct diagnostic criteria are in use, each contributing to the ongoing debate about who should be diagnosed with PCOS and what the implications are for their health.
The Shifting Sands of Diagnosis
The National Institutes of Health (NIH) established the first widely used diagnostic criteria in 1990. These criteria focused on the presence of both oligo-ovulation (irregular or infrequent ovulation) or anovulation (absence of ovulation) and clinical or biochemical signs of hyperandrogenism (excess androgens, male hormones).
- NIH Criteria (1990): Requires both oligo/anovulation and hyperandrogenism.
- Rotterdam Criteria (2003): Requires two out of three: oligo/anovulation, hyperandrogenism, or polycystic ovaries.
- AE-PCOS Society Criteria (2006): Requires hyperandrogenism and either oligo/anovulation or polycystic ovaries.
Navigating the Uncertainties
Given the evolving understanding of PCOS and the potential for overdiagnosis, a more cautious and individualized approach to diagnosis is warranted. Rather than applying a one-size-fits-all label, healthcare providers should carefully weigh the benefits and harms for each woman, considering her individual symptoms, risk factors, and preferences. A slower, stepped, or delayed approach to diagnosis may be more appropriate, allowing for ongoing monitoring and evaluation before committing to a lifelong label.