The Diagnosis of Polycystic Ovary Syndrome

One of the challenges facing the medical community has to do with the diagnosis of polycystic ovary syndrome (PCOS). Learn more.
The Diagnosis of Polycystic Ovary Syndrome

Last update: 17 January, 2023

Even though it’s a common condition worldwide, the diagnosis of polycystic ovary syndrome (PCOS) isn’t easy. Not only because of the diversity of causes behind it but also because of the variety of symptoms that it can cause.

While on the one hand, there are women who present the most characteristic and also very noticeable symptoms, others are totally asymptomatic. There are also many cases in which the symptoms are diffuse and of highly variable intensity. Thus, each woman constitutes a very specific case.

Still, professionals can look for three typical features of this syndrome to determine whether or not it’s present. But, is this the only way that the diagnosis of polycystic ovary syndrome can be reached? Is there any type of test that helps to clear up doubts when PCOS is suspected?

Important points regarding the diagnosis of polycystic ovary syndrome

The diagnosis of polycystic ovary syndrome includes a medical interview.
The clinical manifestations of PCOS allow doctors to orient the diagnosis to a great extent, taking into account epidemiological data.

Regarding the main aspects of the diagnosis of polycystic ovary syndrome, in an article published in Elsevier, the following is stated:

  • The diagnosis is one of exclusion.
    • Doctors must know how to differentiate the physiological changes that are typical of age (not only in adolescence but also in other stages of a woman’s life) from other disorders, including hyperandrogenic ones that require specific therapy.
    • Thyroid disease, hyperprolactinemia, Cushing’s syndrome, and congenital adrenal hyperplasia can cause menstrual cycle irregularities similar to those of PCOS.
  • There are 3 characteristics that help detect PCOS: The absence of ovulation, high androgen levels, and ovarian cysts. Doctors look for these characteristics (or Rotterdam guidelines) in order to refine the diagnosis.
  • When giving the diagnosis to the patient, it’s important to do so in detail. Patients must be informed and educated about their disease so that they understand the importance of treatment, medical follow-up, and self-care.
  • The sooner the diagnosis is made and the appropriate treatment is started, the less risk of complications the woman may have.

Unfortunately, as of today, there’s no special test to determine whether a woman suffers from PCOS. Therefore, when there’s suspicion of this, the doctor must assess various issues. The first step for this will be an interview with the patient.

In the interview, the doctor will ask questions in order to know more details about the menstrual cycle, history of PCOS, or infertility. This is because the syndrome is more common in those women who have a family history.

Physical exam

After the interview, the doctor will perform a complete pelvic physical exam, check blood pressure and weight, based on body mass index, and will also look for possible signs of hyperandrogenism, such as:

  • Acne
  • Oily or dry skin
  • Acanthosis nigricans
  • Hair loss (or even male pattern baldness)
  • Excessive hair growth in areas such as the face, neck, chest, back, and other parts of the body (hirsutism)

Lab tests

The diagnosis of polycystic ovary syndrome requires blood tests.
Blood tests are important to evaluate the serum concentrations of certain chemicals.

The laboratory tests that a doctor needs in order to confirm the diagnosis of PCOS are those that check the levels of androgens, cholesterol, and blood sugar.

The Polycystic Ovarian Syndrome Clinical Practice Guide states that:

“Due to the ease of discarding other diagnoses during management, all women with suspected PCOS should be screened for TSH, prolactin, and 17-HP levels. Hyperprolactinemia can present as hirsutism or dysmenorrhea.”

Ultrasound and transvaginal ultrasound

Since cysts aren’t always visible, ultrasound isn’t always used to view the ovaries. However, the doctor may order one in some cases to determine the presence of cysts and other abnormalities.

When a woman appears to have unexplained pain, fertility problems, and other health problems in both the uterus and the ovaries, the doctor may order a vaginal ultrasound as well. This test allows technicians to capture the pelvic structures, that is, the uterus, the ovaries, the tubes, the cervix, and the pelvic area of the woman.

Endometrial biopsy

Although it’s not usually necessary, in some cases (when menstrual periods are abnormal or when ultrasound has revealed that there’s a thickening of the uterine lining, for example) it may be important to request an endometrial biopsy as a complement in order to evaluate how is the tissue.

A second opinion

It’s important to note that the diagnosis of PCOS can take time. It’s not uncommon to seek a second opinion, especially when a clear diagnosis hasn’t been possible before.

While experts try to overcome barriers, the diagnosis of polycystic ovary syndrome remains a challenge. This is why, in part, there are still many cases that are underdiagnosed or even misdiagnosed.

If you’re of childbearing age and have concerns about your menstrual cycle and other discomforts and you also suspect that it could be polycystic ovary syndrome, get a check-up with your trusted gynecologist as soon as possible. Tell them in detail what you notice and don’t hold back any concerns, as the data will help the specialist to find the most accurate diagnosis.

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