To test for Polycystic Ovary Syndrome (PCOS), doctors typically use a combination of clinical evaluation, blood tests, and imaging studies. Diagnosis usually requires meeting at least two of the following criteria: irregular ovulation (often shown by irregular or absent menstrual cycles), signs of elevated androgen levels (clinically or via blood tests), and polycystic ovaries visible on ultrasound
Key diagnostic steps for PCOS:
1. Medical history and physical exam:
- The doctor asks about your menstrual cycle regularity and symptoms such as excessive hair growth, acne, or hair thinning.
- A physical exam checks for signs of androgen excess like hirsutism (excess hair), acne, and scalp hair thinning
2. Blood tests:
- Hormone levels are measured, including:
- Luteinizing hormone (LH) — often elevated in PCOS
- Follicle-stimulating hormone (FSH) — usually normal or low-normal
- Testosterone and free androgen index — often elevated
- Sex hormone binding globulin (SHBG) — may be low
- Other hormones like estradiol, prolactin, thyroid-stimulating hormone (TSH), and 17-hydroxyprogesterone may be tested to rule out other conditions
- Blood tests help confirm biochemical hyperandrogenism and exclude other causes of symptoms.
3. Ultrasound scan:
- A transvaginal ultrasound is performed to look for polycystic ovarian morphology, defined as 12 or more small follicles in each ovary or increased ovarian volume.
- This imaging helps identify the presence of multiple immature follicles (cysts) characteristic of PCOS
Additional notes:
- There is no single definitive test for PCOS; diagnosis is based on a combination of clinical, biochemical, and imaging findings.
- Blood tests for androgens should ideally be done after stopping hormonal contraceptives for accurate results.
- Anti-Müllerian hormone (AMH) levels can also be used as a marker of follicle number but are less commonly available
In summary, testing for PCOS involves a thorough clinical evaluation, blood hormone testing, and pelvic ultrasound to check for cysts on the ovaries. Meeting two of the three main criteria (irregular ovulation, high androgen levels, polycystic ovaries) confirms the diagnosis
