From the Guidelines
Yes, it is possible to have Polycystic Ovary Syndrome (PCOS) with a regular menstrual cycle if you have hirsutism. While irregular periods are a common symptom of PCOS, not all women with the condition experience menstrual irregularities. PCOS is diagnosed when at least two of three criteria are present: irregular or absent periods, clinical or biochemical signs of hyperandrogenism (such as hirsutism), and polycystic ovaries on ultrasound 1. This means that hirsutism alone, which is excessive male-pattern hair growth caused by elevated androgens, can be a significant indicator of PCOS even with regular cycles. The underlying hormonal imbalance in PCOS, particularly elevated testosterone and other androgens, can cause hirsutism without necessarily disrupting your menstrual cycle. Some key points to consider in the diagnosis and management of PCOS include:
- The use of ultrasonographic criteria in the diagnosis of PCOS, including the evaluation of polycystic ovary morphology (PCOM) 1
- The importance of assessing biochemical hyperandrogenism, which can be accomplished through the measurement of circulating androgen concentrations or clinical signs such as hirsutism, acne, or androgenic alopecia 1
- The role of hormonal treatments, such as oral contraceptive pills or anti-androgenic medications like spironolactone, in managing symptoms of PCOS, including hirsutism 1
- The potential benefits of lifestyle modification and insulin-sensitizing agents, such as metformin, in improving menstrual cyclicity and hyperandrogenism in women with PCOS 1 If you have hirsutism and suspect PCOS, it's essential to consult with a healthcare provider who can perform appropriate tests, including hormone level assessments and possibly an ultrasound, to confirm the diagnosis. Treatment options for hirsutism in PCOS may include hormonal birth control pills (containing ethinyl estradiol with anti-androgenic progestins like drospirenone), spironolactone (starting at 50-100mg daily), or topical treatments like eflornithine cream, depending on severity and individual factors.
From the Research
Definition and Diagnosis of PCOS
- Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology 2.
- The diagnosis of PCOS is primarily clinical, based on the presence of at least two of the three Rotterdam criteria: oligoanovulation, hyperandrogenism, and polycystic ovaries on ultrasonography 2.
PCOS and Regular Menstrual Cycle
- It is possible to have PCOS with a regular menstrual cycle, as the syndrome is characterized by a range of symptoms, including hyperandrogenism and polycystic ovarian morphology, which can occur independently of menstrual irregularity 2.
- Hirsutism, a common symptom of PCOS, can occur in women with regular menstrual cycles, and is often associated with androgen excess 3.
Hirsutism and PCOS
- Hirsutism is defined as the presence of terminal hair with male distribution in women, and is a common symptom of PCOS, affecting 70-80% of women with the syndrome 3.
- The treatment of hirsutism in PCOS often involves the use of anti-androgens, such as spironolactone, which can help to reduce androgen levels and improve symptoms of hirsutism 4, 5.
- Lifestyle modifications, such as weight loss and exercise, can also help to improve symptoms of hirsutism in women with PCOS 2.
Treatment of PCOS and Hirsutism
- The treatment of PCOS and hirsutism often involves a combination of lifestyle modifications and medical therapies, such as oral contraceptives and anti-androgens 2.
- Spironolactone is a commonly used anti-androgen for the treatment of hirsutism in PCOS, and has been shown to be effective in reducing symptoms of hirsutism in women with the syndrome 4, 5.
- The use of spironolactone in PCOS has been associated with a range of benefits, including improved symptoms of hirsutism and acne, as well as reduced androgen levels 5.