Underdiagnosed, Common Women’s Hormonal Imbalance

Where would you start if Joelle, a 25-year-old female, came to you reporting years of hirsutism, cystic acne, and irregular and painful periods? What if that patient also had an elevated BMI with high abdominal adiposity, elevated testosterone, prediabetes, and a single cyst found in a pelvic ultrasound?

PCOS is a complex endocrine and metabolic condition.¹ Although estimates vary due to different standards for diagnosis, it potentially affects up to 15-20% of women.¹ Despite being the most common hormone disorder in reproductive-age women, it is underdiagnosed.² Patients with PCOS do not all seek care and are not always aware that their symptoms can be ameliorated.³

One survey showed that two-thirds of PCOS patients are unsatisfied with their experience of diagnosis, and only 15% were satisfied with the information and materials they received.⁴ Almost half of the women saw more than three clinicians before a diagnosis was obtained.⁴

PCOS comes with major health risks, so early diagnosis can reduce the long-term health impacts. Common comorbidities include infertility, hypertension, type 2 diabetes, depression, anxiety, sleep apnea, menstrual irregularities, and more.^1,2 In one study, 42% of women with PCOS also had irritable bowel syndrome (IBS), and these patients had both higher BMI and higher body fat percentages.⁵ Insulin resistance is found in 50-70% of females with PCOS.¹ Women with PCOS are also more likely to have anxiety or depression, even when compared with controls with the same BMI.⁶

In a primary care practice, patients with PCOS are common. One estimate found that 500,000 patient visits a year are associated with PCOS.⁷ Functional Medicine offers tools to diagnose and treat these patients effectively. For example, a comprehensive Functional Medicine physical exam can aid in an accurate diagnosis, as acanthosis nigricans and hirsutism are common physical findings in these patients.⁸