PCOS diagnosis: How does the doctor diagnose PCOS?

Verified by Dr. Vaishali Sakpal Rane (MBBS, DGO Obstetrics and Gynaecology, DNB Obstetrics and Gynaecology)

Polycystic ovarian syndrome commonly called PCOS is an endocrinological disorder with a wide range of clinical features. There is complex involvement of some hormone secretion like gonadotropins, insulin,  androgens and ovarian hormones.

PCOS diagnosis requires a meticulous history of the patient, physical examination, certain blood tests and ultrasound.

The most widely followed criteria for PCOS diagnosis is the Rotterdams Criteria which focuses on 3 main criteria:

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1. Irregular menses
2. Hyperandrogenism ( clinical or laboratory confirm led)
3. Ultrasound features 

If any 2 criteria from 3 is fulfilled, it is considered for PCOS diagnosis.

Irregular menses ( lesser menses in a year or cycle length more than 35 days) is the leading complaint that women bring to the doctor. 50 % of females with irregular menses will have PCOS. In some females the condition is so severe that they do not bleed without taking medicines.

Most of the women with PCOS are obese but sometimes thin and lean patients may also have PCOS. Many women also present with acne, hirsutism ie excessive male pattern hair growth like on lips, side burns , chest , lower abdomen , ears. These are clinical features of excess androgen hormone in the body. The doctor may ask you to get blood tests to know the androgen levels in the body.

Ultrasound of the lower abdomen forms the cornerstone in diagnosis of PCOS. The classical picture seen is bulky ovaries with tiny follicles (fluid filled balloon like structure) in the periphery giving the appearance of a string of pearls. This picture is seen as there is no ovulation occuring or it occurs very rarely.

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PCOS patients also develop increased insulin resistance, that is for a certain amount of glucose to be utilised more than normal amount of insulin is required. Fasting serum insulin level with Glucose tolerance test is done to know the status of insulin resistance.

Some patients develop excessive darkening with the velvety appearance of certain areas of skin like the nape of neck, arm pit ,below the breasts, groins, inner thighs. This condition is called Acanthosis Nigricans and it indicates insulin resistance. 

Don’t delay your diagnosis if you are having any of these symptoms. Do consult a doctor for the right diagnosis and treatment.