PCOS: The Most Underdiagnosed Hormonal Condition in Women
Polycystic ovary syndrome affects an estimated 8–13% of women of reproductive age and is the most common cause of anovulatory infertility worldwide. Despite its prevalence, the average time from symptom onset to diagnosis is over two years — because PCOS presents differently in different women and is frequently attributed to stress, weight, or normal variation rather than investigated as a hormonal condition.
PCOS is a syndrome, not a single disease — meaning the diagnosis is made when a patient meets at least two of three criteria: irregular or absent ovulation, clinical or biochemical evidence of elevated androgens, and polycystic ovarian morphology on ultrasound. A woman does not need to have cysts on her ovaries to have PCOS, and a woman with cysts does not necessarily have PCOS. The diagnosis requires clinical evaluation, not just imaging.
Dr. Andrei evaluates and manages PCOS as a complete clinical picture — addressing the menstrual abnormalities, the androgen excess symptoms (acne, hair growth, hair loss), the metabolic implications (insulin resistance, weight management, cardiovascular risk), and the fertility considerations — in a gynecology-only practice that has the time and focus to do this thoroughly.
How PCOS Presents at Lapeer Women’s Health
PCOS does not look the same in every patient. Dr. Andrei evaluates the full range of presentations — not just the classic picture.
Irregular or absent periods
Cycles that are unpredictable, fewer than 8 per year, or absent entirely — the most common presenting symptom and the one most directly caused by anovulation.
Acne with hormonal pattern
Persistent acne concentrated around the jaw, chin, and lower face that has not responded adequately to standard dermatologic treatment — driven by elevated androgens.
Hirsutism
Coarse dark hair growth on the face, chest, abdomen, or inner thighs — one of the most distressing PCOS symptoms and one of the clearest indicators of androgen excess.
Unexplained weight gain and difficulty losing weight
Central weight gain and metabolic resistance to weight loss — driven by the insulin resistance component of PCOS that affects the majority of women with the condition.
Infertility from irregular or absent ovulation
PCOS is the most common cause of anovulatory infertility. Women who are not ovulating regularly cannot reliably conceive without medical support.
Hair thinning or female-pattern hair loss
Androgenic alopecia — thinning at the crown and top of the scalp — is a less commonly discussed but clinically significant PCOS manifestation.
How Dr. Andrei Evaluates and Manages PCOS
PCOS management at Lapeer Women’s Health is individualized based on which features are driving the patient’s symptoms and what her goals are — cycle regulation, androgen control, metabolic health, or fertility.
- Complete hormonal panel: LH, FSH, free and total testosterone, DHEA-S, prolactin, 17-OH progesterone
- Metabolic panel: fasting glucose, insulin level, HbA1c, lipid panel
- Thyroid function: TSH and free T4 to exclude thyroid-driven cycle irregularity
- Transvaginal ultrasound: ovarian morphology and endometrial assessment
- BMI, blood pressure, and metabolic risk stratification
“PCOS is not just a period problem — and I do not treat it that way. The metabolic component matters as much as the menstrual component, and the right management approach depends entirely on what is driving the patient’s individual picture.”
- Combined oral contraceptives for cycle regulation and androgen reduction
- Metformin for insulin resistance and metabolic management
- Anti-androgen medications (spironolactone) for hirsutism and acne
- Lifestyle counseling: dietary approach, activity, and weight management specific to PCOS physiology
- Fertility evaluation and ovulation induction referral when conception is the goal
- Long-term monitoring: annual metabolic panel and cardiovascular risk assessment
What Patients Ask About PCOS Diagnosis and Management
PCOS Diagnosis That
Leads to Real Management.
Structured PCOS evaluation with targeted labs, cycle assessment, and a management plan built around your specific symptom profile — hormonal, metabolic, and lifestyle components all addressed.
The information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.