Diagnosis and tests for PCOS

There is no single test for PCOS. A doctor diagnoses it by looking at symptoms and ruling out other causes.

Rotterdam criteria (two of three)

• Irregular or absent ovulation
• Clinical or blood signs of high androgens
• Polycystic ovaries on ultrasound. In teenagers, ultrasound is usually not used in the first years after periods start.

Examination

Height, weight, waist, blood pressure, hair growth (Ferriman-Gallwey score), acne, hair loss and dark skin patches.

Blood tests

• Androgens: total and free testosterone, DHEAS
• Thyroid (TSH) and prolactin, to rule out other causes
• 17-hydroxyprogesterone, if indicated, for congenital adrenal hyperplasia
• Blood sugar: fasting glucose, HbA1c or glucose tolerance test, and insulin where useful
• Lipids: cholesterol and triglycerides
• FSH, LH and AMH: AMH is not required for diagnosis
• Pregnancy test when periods are missed

Ultrasound

Pelvic ultrasound looks at ovary size, follicle number and the lining of the uterus. A transvaginal scan gives better detail in adults, and an abdominal scan can be used if that is not suitable.

Screening for related problems

Blood pressure, sleep apnoea, fatty liver, mood and anxiety.

Ayurvedic view

Ayurvedic assessment does not replace hormone tests and ultrasound for diagnosis.

See a doctor if you have irregular periods with acne or excess hair, or have trouble conceiving.

When to get help

See a gynaecologist or endocrinologist if your periods are very irregular or absent, you have rapid hair growth or hair loss, you have been trying to conceive for 6 to 12 months, or you have symptoms of high blood sugar such as thirst and frequent urination.

Remember

PCOS is diagnosed by pattern and exclusion. Having cysts on a scan alone does not mean PCOS.