16 responses to “Diagnosis and treatment of polycystic ovary syndrome (PCOS) using virtual health”

  1. Interesting new update

  2. Thanks for sharing,

    Knowing all about the adverse effects of long term hormonal therapy, maybe putting spironolacton prior to OCPs might be another option.

  3. Will now order Anti-Müllerian Hormone

  4. Excellent update
    The algorithm for the new guidelines is an excellent protocol
    Treatment based on Sx and /or need to conceive makes a lot of sense

  5. Very good review and update

  6. Thank you for sharing this fantastic study.

  7. I had not heard of AMH and will be ordering this lab to aid in diagnosis
    The algorithm for treatment and diagnosis is well laid out and useful
    I have had patients conceive after not being able to for years – with metformin alone.

  8. Thanks for the update. Do you know if AMH testing is covered by specialists?

  9. Will add in AMA

  10. HI Shelin
    Thanks for the question. No, AMH is not covered in BC. Everyone pays, regardless of patient age, diagnosis or who orders it.

    I also really appreciate everyone else’s participation. Thank you.

  11. thanks for a great update. Does the FSH and E2 need to be done at a certain time in the menstrual cycle or can the patient do whenever?

  12. Hi Claire
    Ideally do FSH & E2 on cycle day 2 – 4 (early follicular phase). You want to see the E2 low (<200pmol) to ensure it is not falsely suppressing the E2. However….for patients with oligomenorrhea, timing FSH and E2 can be difficult. They can just do a random one. This is another reason that AMH is really helpful, as it is valid anytime in the cycle.

  13. 1) Some patients are already on ocp when seeking diagnosis. How does this affect testing or is it non diagnostic while on ocp?

    2) what follow up investigations are necessary if DHEAs levels elevated? Is there a cut off here can be monitored vs other investigation needed?

  14. Hi Cindy

    1. If the patient is on OCP it is difficult to make the initial diagnosis of PCOS. Menstrual bleeding will be regular (due to OCP) and serum levels of testosterone will be lower (due, in part, to higher sex hormone binding globulin production by the liver as a result of oral estrogen intake). If the patient wants to be tested for the serum androgens, it is valid when off of OCP for 3 months. But again, when keeping things patent-centric, making the diagnosis is less important than treating her symptoms (most of which are treated with OCP first-line).

    2. DHEA-S can be elevated in about 20 – 40% of women with PCOS. Usually for mild elevations, no treatment or further intervention for the DHEA-S is necessary. Because DHEA-S is produced exclusively by the adrenal gland, you may need to rule out an adrenal tumor in situations were DHEA-S is very high, hirsutism is refractory to treatment or becomes virilization, or there are other concerning signs.


  15. Cindy, I should add that anti-Mullerian hormone (AMH) is valid while on OCP.

  16. Great review and comments. A true refresher!

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