Diagnosing Polycystic Ovary Syndrome

Each woman’s experience of polycystic ovary syndrome (PCOS) is unique because no two have the exact same symptoms. This can make diagnosing PCOS difficult. A diagnosis of PCOS can take some time to get to and is based on medical history, physical exam, lab tests, and a review of your symptoms.

Tests and Procedures to Diagnose Polycystic Ovary Syndrome

To be diagnosed with PCOS, you must meet at least two of the following three criteria:

1. Irregular or absent periods (fewer than eight menstrual cycles per year)

2. Blood results or physical signs of hyperandrogenism (high androgens) without another medical cause

3. The appearance of small follicles on an ultrasound of the ovaries

See the difference between a normal and polycystic ovary.

Physical Exam and Medical History

Your doctor will want to do a complete physical and pelvic exam to get to the bottom of your issue. 

When a woman has infrequent, absent, or irregular periods (eight or fewer menstrual cycles in a year), it is a sign that ovulation may not be occurring and could indicate PCOS. It is important to note, though, that women with PCOS can have a monthly menstrual cycle and have PCOS. Coming to a diagnosis involves ruling out other conditions that could be causing your irregular periods, such as thyroid diseasehyperprolactinemiaCushing's syndrome, or congenital adrenal hyperplasia, first.

Your doctor will look for physical signs of high androgens or testosterone like abnormal hair growth (specifically on the face, lower abdomen, back, and chest), acneskin tags, male pattern baldness (if applicable), and acanthosis nigricans (darkened thick skin on the neck, thighs, armpits, or vulva. He or she will then ask you about any other unusual symptoms you may have noticed, so make sure to mention any of your concerns, even if you think they are no big deal.

Writing a list of things you want to mention and ask ahead of time can help you remember important points you want to raise in your appointment. You will be asked about your menstrual periods—how regular they are, the length of time between them—so it's best to come prepared with those answers too. (This information may help your doctor determine if you are ovulating.)

Transvaginal Ultrasound for PCOS

Transvaginal ultrasound may or not be performed to rule out PCOS. This test may be familiar to you if you've ever been pregnant. A probe is placed inside the vagina, which allows the physician to examine the reproductive organs, look for abnormalities, and measure the thickness of the endometrium.

Your doctor will look for 12 or more small (2 to 9 mm) follicles in each ovary to help confirm a diagnosis. Often times these follicles are called cysts. However, there are many women who have cystic-appearing ovaries without symptoms of hyperandrogenism, and many women who have been diagnosed with PCOS who do not have classically cystic ovaries. Some doctors find the use of a transvaginal ultrasound in adolescents unnecessary, as they may not have the appearance of follicles and may not yet be sexually active.

Blood Results

Finally, blood work will most likely be taken. Besides testing for hormones like testosterone, estrogen, and follicle stimulating hormone (FSH), your doctor may want to check your body for signs of metabolic complications like high cholesterol, fatty liver, type 2 diabetes, and insulin resistance.

Other Tests Your Doctor May Recommend

Endometrial Biopsy: An endometrial biopsy can be performed to determine if your endometrial tissue is in the correct phase or to test for endometrial cancer.  This risk of endometrial cancer increases with the number and length of time between missed periods, and the disease is related to hormone imbalances found with PCOS.

The biopsy can be done in your doctor’s office and is relatively painless, although you may experience minimal cramping during the procedure. A small amount of tissue is removed from your uterus through a thin catheter placed through the cervix and into the uterus. This tissue is then analyzed in the context of your cycle and examined for cancer cells.

Oral Glucose Tolerance Test: Women with PCOS are at a much higher risk of developing type 2 diabetes. In fact, according to the Androgen Excess and PCOS Society (AEPCOS), there is a rapid conversion from pre-diabetes to diabetes in those affected. For this reason, AEPCOS recommends that women with PCOS have an oral glucose tolerance test annually if they have impaired levels of glucose, or every other year if glucose levels are normal. This way, diabetes can be detected and treated sooner, helping to prevent complications.

Other Hormone Levels: Again, PCOS is a condition of exclusion, so other conditions that have similar signs and symptoms need to be ruled out before a diagnosis is reached. To do this, other hormones, such as follicle stimulating hormone, luteinizing hormone, and prolactin, may be checked. Your doctor may also test your thyroid hormone levels, as thyroid disorders have similar signs and symptoms as PCOS and are common among women with these concerns. A new hormonal blood test, looking at a woman's AMH (anti-mullerian hormone) is now being used by some physicians as a diagnostic tool as well.

Making Sense of Your Results

When your blood results come back, you should be able to review them with your doctor and ask questions. If possible, get copies of your blood results sent to you. Many labs now offer free apps you can download to have your blood results sent to your smartphone.  

If you do get diagnosed with PCOS, remember that lifestyle modifications can improve your lab values and reduce your risk for further medical complications. Ask your doctor how he or she plans to treat your PCOS and what you can do. Be sure to ask about other treatment options available, too.

Your Next Steps After PCOS Diagnosis

Being diagnosed with PCOS can be very overwhelming at first. You may want to reach out to the people who care about your, or perhaps a PCOS support group in your area, to have someone to lean on. Following your doctor's advice and learning about your disease is the best way to manage it. We have plenty of information about PCOS treatment, including the variety of medications that may be recommended, right here on Verywell.

Seeking the guidance of other health professionals, such as a registered dietitian nutritionist or therapist, may also be helpful.

A Word From Verywell

While this may all seem like a lot to process, remember that you are not alone. As the most common endocrine disorder among women of childbearing age, there are many women with PCOS who have been through this. The more you know, the more you'll feel control of what comes next.

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Article Sources
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  • Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Glucose intolerance in polycystic ovary syndrome—a position statement of the Androgen Excess Society. J Clin Endocrinol Metab. 2007;92(12):4546-56.