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How Is Polycystic Ovary Syndrome (PCOS) Diagnosed?

06.09.2023 / Clara Siegmund
How Is Polycystic Ovary Syndrome (PCOS) Diagnosed?

Polycystic ovary syndrome (PCOS) is a condition that affects hormone levels in people with ovaries. This condition causes hormonal imbalances that can interrupt or alter ovarian function. Between 6% to 12% of reproductive-age people with ovaries have a PCOS diagnosis. But how is PCOS diagnosed?

There isn’t one, single test that diagnoses PCOS, but certain signs may indicate that you should consider having your doctor do a check-up to see if you meet the PCOS diagnosis criteria.

Signs     PCOS diagnosis    Diagnosis criteria     Post-diagnosis

Common signs of PCOS

Signs and symptoms of PCOS can vary from person to person. Some people have a combination of symptoms, while others have just one. 

The three main features associated with PCOS are:

  • High levels of hormones generally more present in people assigned male at birth (AMAB), such as androgen or testosterone
  • Irregular menstrual cycles or infrequent to no ovulation
  • Polycystic ovaries, or small fluid-filled sacs (follicles) surrounding the eggs



These features can lead to different signs and symptoms. Here are some of the most common PCOS symptoms:

  • Irregular periods
  • Very heavy periods
  • No periods
  • Menstrual cycles without ovulation (anovulatory cycles)
  • Infertility
  • Weight gain
  • Excess body or facial hair growth (hirsutism)
  • Thinning hair or hair loss on the head
  • Oily skin or acne
  • Patches of thick, darkened skin (acanthosis nigricans) 

Some signs of PCOS may not seem like symptoms of a health condition, and telling a doctor about them might not feel necessary. This is one of the reasons that PCOS can go undiagnosed for many people – that is, until they start experiencing irregular cycles, missing periods, or having trouble conceiving. 

>>MORE: PCOS Awareness Starts with You: Here's How Oova Can Help

For people dealing with female-factor infertility, PCOS is one of the most common underlying causes. However, PCOS exists outside of the sphere of fertility and conception, as well, and people who aren’t trying to conceive also experience the effects of this condition. For some people, PCOS can start as early as their first period. Others develop the condition in their 20s or 30s. 

If you’re experiencing these symptoms, you may want to consider making an appointment with your doctor to get checked out, even if your symptoms don’t seem like a big deal.

PCOS diagnosis

So, you’re experiencing symptoms that could be related to PCOS and you’ve made an appointment with your doctor. 

While there isn’t currently one, single test to diagnose PCOS, there are a few things your doctor will likely do to rule out other conditions and arrive at your diagnosis. Here’s how they will proceed.

Medical history review

To begin, your doctor will conduct a thorough review of your medical history. You can expect questions about:

  • Your menstrual cycle
  • The regularity of your periods
  • The symptoms you’ve been having
  • Any history of PCOS in your family, as the condition can run in families

Physical exam

Your doctor will also do a complete physical exam. Among other things, they will look for physical signs that could indicate high levels of certain hormones, like androgen and insulin. These signs include:

  • Excess hair growth, consistent with hirsutism
  • Oily skin or acne
  • Darkened patches of skin 


After these initial steps, your doctor will run some tests. These may include:

  • Blood tests
  • Pelvic exams
  • Ultrasounds

Blood tests check your hormone levels. Pelvic exams are one way to look for growths or abnormalities on your ovaries. Ultrasounds allow your doctor to examine your ovaries more closely and check the thickness of your uterine lining.

PCOS diagnosis criteria

How does a doctor confirm if you have PCOS? After your medical review, exam, and tests, your doctor will determine if you meet the criteria for a PCOS diagnosis. There are three criteria that your healthcare provider looks for:

  • Irregular periods, infrequent periods, or no periods, indications that you’re not regularly ovulating
  • High levels of hormones typically more present in people who are AMAB (such as androgen or testosterone), or physical signs that these hormones are elevated, even if your blood tests come back normal
  • Polycystic ovaries, or small fluid-filled sacs (follicles) surrounding the eggs

If other conditions have been ruled out and you display at least two out of these three criteria, your doctor will diagnose you with PCOS.

>>Oova insight: It’s possible to receive a PCOS diagnosis without doing an ultrasound, since your doctor may be able to determine that you meet the other two diagnosis criteria without needing to check for polycystic ovaries.

What happens after a PCOS diagnosis?

After you receive a PCOS diagnosis, your doctor will work with you to figure out next steps based on your unique situation and what you need and want out of your treatment.

Managing your symptoms

Treating PCOS largely revolves around managing the symptoms that you’re concerned about. You and your doctor can determine which symptoms you want to treat and find the best ways to accomplish that.

  • Regulating your cycle: Your doctor might recommend hormonal birth control or hormone therapy to help regulate your cycle. 
  • Acne: Your doctor may prescribe hormonal birth control pills, other medications, or topical creams.
  • Excess hair growth: This may also be treated with hormonal birth control pills. This PCOS symptom may also respond to other types of medication or hair removal options.
  • General symptom management: For some people, changes to diet, exercise habits, or lifestyle may help relieve symptoms, either alone or when combined with medication.
  • Infertility: If you’re trying to conceive, your doctor might prescribe certain medications that can help stimulate ovulation. If you haven’t gotten pregnant after one year of unprotected sex (or six months, if you’re over 35), you may be dealing with infertility. This could be related to your PCOS or to other factors.

Seeing a specialist

It’s possible that your primary care doctor may refer you to a specialist to help determine your specific courses of treatment. Some of the specialists you could see are:

Monitoring your overall health

It’s important to monitor your overall health, as well. PCOS can affect your body in ways unrelated to your reproductive health, and these effects can continue after menopause. PCOS can increase your risk for conditions such as:

  • Type 2 diabetes
  • Heart disease
  • Endometrial cancer
  • High blood pressure
  • Sleep apnea
  • Depression

Depending on your situation, your healthcare provider may recommend regular screening for these complications. 

>>MORE: PCOS Treatments: Helping the Whole Person, Not Just Their Symptoms

The takeaway 

If you’re noticing symptoms of PCOS, don’t hesitate to bring them up with your doctor, even if they seem unrelated to a health condition. Talking to your healthcare provider about anything and everything that you’re experiencing can help them start to piece together what may be going on in your body. This, in turn, can be the first step towards diagnosing PCOS. 

Even though there’s currently no cure for PCOS, the condition can still be manageable. After your diagnosis, you can work with your doctor (or doctors) to help establish your treatment goals and manage the symptoms that you want to address.


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