Diagnosing PCOS

Diagnosing PCOS

There are a number of symptoms that women with PCOS can have (see Symptoms). However, not every woman with PCOS will have every symptom and each woman will be quite individual in her presentation.

A diagnosis of polycystic ovary syndrome is made when at least two out of three of the following criteria are met:

  1. Polycystic ovaries are present on the ultrasound
  2. High levels of male hormones are in the blood (hyperandrogenism), or symptoms suggesting an excess of male hormones are present (e.g. excessive hair growth, acne)
  3. Menstrual dysfunction (e.g. lack of menses (menstrual flow), menstrual irregularity or lack of ovulation)

With these diagnostic criteria, a woman can be diagnosed with PCOS even with regular periods or normal androgen levels. This means that women with PCOS can present with very different types of symptoms.

To make sure the diagnosis of PCOS is correct, a number of other conditions that could cause similar symptoms of menstrual dysfunction have to be excluded.

Testing for PCOS

Below are some of the tests your health practitioner may recommend in testing for PCOS and excluding other conditions. Please note: not all tests are necessary in every woman.

Medical examination

A thorough medical history and examination, including weight and BMI

Ultrasound

A transvaginal ultrasound of the uterus, ovaries and the pelvis. 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). Transvaginal ultrasounds are only performed on women who have been sexually active in the past, otherwise an abdominal scan is done (viewing the ovaries through the tummy wall).

Blood tests

Hormonal blood tests such as:

Blood tests for androgens (testosterone) and free androgen index (FAI) are the best tests for diagnosing androgen excess. Other blood tests that can be useful in diagnosing androgen excess include sex hormone binding-globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS) and androstenedione.

Blood tests for other reproductive hormones e.g. oestradiol, follicle stimulating hormone (FSH) and Luteinizing Hormone (LH).

Blood tests to exclude other conditions which can mimic PCOS symptoms.

These include measurement of thyroid stimulating hormone (TSH), prolactin levels and hormones related to adrenal function (e.g. 17-hydroxyprogesterone).

Assessing risk factors for cardiovascular disease and diabetes are important in PCOS and especially in overweight women.

This includes blood tests for cholesterol, blood pressure and blood tests for glucose metabolism (glucose tolerance tests). Women with PCOS should have their cholesterol levels measured every two years, their blood pressure measured every year and have a two hour oral glucose tolerance test every two years. If a woman with PCOS is overweight or gaining weight or has other risk factors such as abnormal lipid levels, a history of diabetes in pregnancy or a family history of diabetes then these tests should be performed more frequently.

If you suspect you may have PCOS, you will need to visit your Family Physician or General Practitioner and undertake the appropriate investigations. Women diagnosed of possible PCOS, are usually suggested to see an Endocrinologist and attend education and lifestyle management sessions and be referred on to additional specialists as required.