Diagnosis of polycystic ovary syndrome

polycystic ovary syndrome (PCOS) can be a complex condition to identify because there are numerous symptoms, and you don’t have to have all of them to be diagnosed with PCOS. Very few women have the same set of symptoms, and the symptoms can change at different stages of your life.

The symptoms differ widely between women, but the three main areas they affect are:

  • fertility and reproductive health
  • metabolic health
  • psychological health.

Although there is no cure for PCOS, the good news is that PCOS is treatable. We know that our lifestyle (what we eat and how active we are) can worsen or improve the symptoms of PCOS. With support from your doctor and other health-care givers, there are many ways to manage your lifestyle and improve all aspects of PCOS.

Criteria for a diagnosis of PCOS

A diagnosis of PCOS can be made when at least two of the following three criteria are met:

1. Irregular periods or no periods

2. Higher levels of androgens are present in the blood (hyperandrogenism), shown by:

  • a blood test, OR
  • symptoms such as:
    • excess facial or body hair growth
    • scalp hair loss
    • acne.

3. Polycystic ovaries are visible on an ultrasound, meaning:

  • more than 20 follicles (partly developed eggs) are visible on one or both ovaries or
  • the size of one or both ovaries is increased (more than 10ml).

You do not need to have an ultrasound if you have criteria 1 and 2.

In women younger than 20 years, ultrasounds are not recommended. This means that irregular periods and hyperandrogenism need to be present for a diagnosis of PCOS to be made.

A number of other conditions that could cause similar symptoms of irregular periods or no periods need to be checked by your doctor and ruled out before a correct diagnosis of PCOS can be confirmed.

When to see your doctor

If you think you might have PCOS, you need to see your doctor.

Below are some of the tests your doctor might recommend to test for PCOS and to exclude other conditions. The signs and symptoms of PCOS can be similar to other conditions, so it is important to rule these out before a diagnosis of PCOS can be made.

Not all tests are necessary for every woman – tests will be suggested based on your individual symptoms.

Diagnosis & tests

Medical history & examination

As part of the diagnosis, your doctor will review your medical history and assess your physical symptoms, weight and BMI (body mass index).

Blood tests

Hormonal blood tests

Blood tests are used to assess the levels of androgens in your body. Blood tests for testosterone and free androgen index (FAI) are the best tests for diagnosing whether you have hyperandrogenism (high androgen levels).

Other blood tests that can be useful in identifying high androgen levels include:

  • sex hormone-binding globulin (SHBG)
  • dehydroepiandrosterone sulphate (DHEAS)
  • androstenedione.

Blood tests also might be done to assess the levels of other reproductive hormones in your body, as these can also affect your periods. These can include testing your levels of:

  • oestradiol (oestrogen, the main female sex hormone)
  • follicle-stimulating hormone (FSH)
  • luteinising hormone (LH).

Blood tests to exclude other conditions that have similar symptoms to PCOS might measure the levels of:

  • thyroid-stimulating hormone (TSH)
  • prolactin
  • hormones related to adrenal function (glands found above the kidney), eg, 17-hydroxyprogesterone.


An ultrasound might be carried out to provide an image (picture) of the uterus, ovaries and the pelvis. The image shows whether there are any ‘cysts’ (partly developed eggs) on your ovaries and whether an ovary is enlarged. It is also useful to assess the lining of the womb (endometrium), which may become thickened if periods are very irregular, which is a risk factor for womb cancer.

An ultrasound is not needed if periods are irregular and there are signs or measurements of high levels of androgens, and the woman is aged less than 20 years. If there are very high levels of androgens or an unusual set of symptoms (for example, severe scalp hair loss or excess hair growth, or failure to develop periods altogether) then an ultrasound might still be necessary.

Transvaginal ultrasound

Transvaginal ultrasounds are performed only on women who have been sexually active, otherwise an abdominal scan is done. A transvaginal ultrasound is a painless test with no radiation. It uses a pen-shaped probe with an ultrasound sensor on the tip, which is inserted into the vagina. This produces a much clearer picture than an abdominal ultrasound.

Abdominal ultrasound

In an abdominal ultrasound, the ovaries are viewed from the outside through the stomach wall.

Other tests

Assessing your risk of developing cardiovascular (heart) disease and diabetes is important when testing for PCOS because there are links between PCOS, insulin resistance and being overweight. Tests to assess these risks can include:

  • cholesterol blood test
  • blood pressure
  • glucose metabolism/ tolerance blood test.

If you have PCOS, you will need a cholesterol and diabetes test every 1-3 years, and a blood pressure check every year. If you have risk factors such as a family history of diabetes or previous abnormal cholesterol tests, you will need these tests more often.

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