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Polycystic ovary syndrome

How do doctors diagnose polycystic ovary syndrome?

It often takes a long time to get diagnosed with polycystic ovary syndrome (PCOS). Many women aren't diagnosed until they are in their 30s. This is partly because there are so many different symptoms.

Many women have only one or two of the symptoms of PCOS.

Source:
Rosenfield RL.
Hirsutism.
New England Journal of Medicine. 2005; 353: 2578-2588.

¹ This can make it hard for doctors to spot. Also, many women don't go to the doctor until they've had symptoms for quite a long time. You might not be worried about irregular periods, for example, until you start trying to get pregnant.

There's no single test or symptom that shows you have PCOS. Doctors look to see if you have two of the three main symptoms of PCOS.

Source:
The Rotterdam ESHRE/ASRM-sponsored PCOS consensus.
Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).
January 2004. Available at http://humrep.oxfordjournals.org/cgi/content/short/19/1/41 (accessed on 18 August 2009).

² These are:

Your ovaries don't release eggs, or don't release them regularly. Your doctor will check this by asking about how often you have periods
You have high amounts of hormones called androgens. Signs that you have high levels of these

hormones
Hormones are chemicals that are made in certain parts of the body. They travel through the bloodstream and have an effect on other parts of the body. For example, the female sex hormone estrogen is made in a woman's ovaries. Estrogen has many different effects on a woman's body. It makes the breasts grow at puberty and helps control periods. It is also needed to get pregnant.

hormones include unwanted hair or pimples (acne). Or your doctor can do blood tests to find out the amount of androgens in your body
Your ovaries are covered in small fluid-filled swellings (cysts). It's possible to check for cysts using an

ultrasound
Ultrasound is a tool doctors use to create images of the inside of your body. The ultrasound machine sends out high-frequency sound waves, which are directed at an area of your body through a device such as a probe. The waves reflect off parts of your body to create a picture. Ultrasound is often used to see a developing baby inside a woman's womb.

ultrasound. But not all women will need this test.

Your doctor will also do tests to rule out anything else that could be causing your symptoms.

² You're most likely to need blood tests.

Here are some things your doctor might do to figure out if you have polycystic ovary syndrome.

Questions your doctor might ask

Your doctor will want to know about the symptoms you are having, when you first noticed them, and whether they have changed over time. He or she will want to know:

Source:
Lane DE.
Polycystic ovary syndrome and its differential diagnosis.
Obstetrical and Gynecological Survey. 2006; 61: 125-135.

When your periods started
How often you have periods
Whether you've ever had regular periods
What your periods are like, if you get them. For example, are they heavy?

This will help your doctor figure out whether PCOS is the cause of your problems. Most women with PCOS started their periods around the usual time (about 11 to 16 years of age) but have never had regular periods.

Women with PCOS often have trouble getting pregnant, and are more likely to have a miscarriage early in their pregnancy.

Source:
Richardson MR.
Current perspectives in polycystic ovary syndrome.
American Family Physician. 2003; 68: 697-704.

⁴ So your doctor will ask:

Whether you have ever been pregnant, or tried to get pregnant
Whether you've ever had a miscarriage.

Lots of medicines can affect your hormones. These may give you some of the same symptoms as PCOS. So your doctor will want to check what medicines you're taking.

Women with PCOS often take great care to hide symptoms like hair on their faces, pimples or hair loss. For example, you may shave or wax unwanted hair. So, your doctor will ask:

Whether you've had any of these symptoms
When you started getting them, and how quickly they came on
Whether anything seems to make them better or worse.

Finally, PCOS seems to run in families. So your doctor will ask whether anyone in your family has had PCOS. And because PCOS is linked to blood sugar and

insulin
Insulin is a hormone that helps your body use glucose, a type of sugar that gives you energy. Insulin keeps your levels of glucose steady. It also helps glucose get into your cells from your blood. People who have diabetes do not have enough insulin or do not react to insulin strongly enough. This leads to too much glucose in their blood.

insulin levels, he or she will also ask whether anyone in your family has had

diabetes
Diabetes is a condition that causes too much sugar to circulate in your blood. It happens when your body stops making a hormone called insulin (type 1 diabetes) or when insulin stops working (type 2 diabetes).

diabetes.

Physical exam

Your doctor will want to examine you without your clothes on to see which symptoms of PCOS you have.

Source:
Lane DE.
Polycystic ovary syndrome and its differential diagnosis.
Obstetrical and Gynecological Survey. 2006; 61: 125-135.

Although you can probably tell the doctor about most things, there may be some symptoms that you've missed. Also, it's hard to explain things like how much hair you have, exactly where it is, and what type of hair you have. If you are very self-conscious about the hair on your body, you might describe it as being worse than it really is. It's easier for the doctor to look and see, even though you might find this embarrassing.

Your doctor will be looking to see:

Source:
Lane DE.
Polycystic ovary syndrome and its differential diagnosis.
Obstetrical and Gynecological Survey. 2006; 61: 125-135.

How much hair you have on your face and body, where it is and what sort of hair it is
Whether you have pimples (acne) on your face, shoulders or back
Whether you have raised patches of velvety skin.

Many women with PCOS are overweight. So your doctor will also check your weight, and may measure your waist. That's because women with PCOS tend to carry extra weight around their abdomen rather than on their hips.

Tests you may need

Doctors don't always agree about which tests you should have for PCOS. But you will almost certainly have some blood tests. These will look to see:

If anything else is causing your symptoms, like a problems with your thyroid gland or an over-active adrenal gland. These glands make hormones, so if they're not working properly they may be causing your symptoms.
What levels of hormones you have in your blood. The tests will probably check for hormones called androgens, as well as follicle-stimulating hormone and estradiol.

The hormone tests are to check whether your hormones are in the usual balance. But there are lots of different hormone tests and they're not all reliable. So your test might not show up any problems, even if you do have problems with your hormones.

Some doctors will check the levels of sugar in your blood. That's because women with PCOS are more likely to get diabetes. Diabetes means your body has trouble controlling the amount of sugar in your blood.

You might have an ultrasound scan of your lower body, to check whether you have fluid-filled swellings (called cysts) on your ovaries. An ultrasound uses sound waves to form a picture of the inside of your body. Not all doctors think you need these scans. But if your other tests are normal and doctors aren't sure whether you have PCOS, you may have a scan.

Lots of women get some cysts on their ovaries. These may not cause any problems. Doctors say you have polycystic ovaries if you have more than 12 cysts, and they're 2 millimeters to 9 millimeters across.

Sources for the information on this page:

Rosenfield RL.Hirsutism.New England Journal of Medicine. 2005; 353: 2578-2588.

The Rotterdam ESHRE/ASRM-sponsored PCOS consensus.Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).January 2004. Available at http://humrep.oxfordjournals.org/cgi/content/short/19/1/41 (accessed on 18 August 2009).

Lane DE.Polycystic ovary syndrome and its differential diagnosis.Obstetrical and Gynecological Survey. 2006; 61: 125-135.

Richardson MR.Current perspectives in polycystic ovary syndrome.American Family Physician. 2003; 68: 697-704.

This information was last updated on Jul 13, 2009

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