Medically reviewed on January 4, 2023 by Amy Harris, MS, RN, CNM. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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If you're struggling with irregular menstrual periods, weight gain, unwanted hair growth, or infertility, you may wonder if you have polycystic ovary syndrome (PCOS).
PCOS is one of the most common health issues faced by women and people born with ovaries and a uterus. Nearly one out of every 10 women has PCOS . So, how can you find out if you have PCOS? Other health conditions can cause the same symptoms as PCOS, so testing for the most accurate diagnosis will help you ensure you get the correct treatment, whether you have PCOS or not.
What is polycystic ovary syndrome (PCOS)?
PCOS is a set of symptoms related to a hormonal imbalance that can affect women and girls of reproductive age . When your ovaries produce too many androgens (male sex hormones such as testosterone), the result is the symptoms associated with PCOS . Your ovaries normally produce some androgens, but excessively high androgen levels disrupt menstrual cycles, resulting in less frequent periods .
So, what causes a person's ovaries to produce excess androgen levels? The specific cause of PCOS isn't fully understood , but it's likely due to a combination of genetic and environmental factors. It may also be associated with insulin resistance, inflammation, and obesity .
What are the most common symptoms of PCOS?
The combination of high androgen levels, insulin resistance, genes, inflammation, and environmental factors results in a range of symptoms for people with PCOS. These often include :
- Irregular menstrual cycles or periods (oligomenorrhea)
- Amenorrhea (the absence of periods)
- Oily skin
- Hirsutism (the growth of excess male-pattern hair on the chest, stomach, back, or face, impacting 7 out of 10 people with PCOS)
- Thinning hair
- Male-pattern baldness
- Abdominal weight gain
- Ovarian cysts
- Enlarged ovaries
- Skin tags on the neck or armpits
- Acanthosis nigricans (the development of dark, thick skin patches on the back of the neck, armpits, or under the breasts)
How do healthcare providers diagnose PCOS?
If you have any of the symptoms listed above, you may want to get tested for PCOS. So, how does the diagnostic process work? Unfortunately, there is not one single test to diagnose PCOS. Instead, PCOS is a diagnosis of exclusion. A diagnosis of exclusion means that your healthcare provider must first rule out other potential conditions before they can diagnose you with PCOS. To do so, they talk with you about your symptoms and your menstrual cycle patterns and often do a physical exam. They may also schedule a blood test and a pelvic ultrasound .
Let's take a closer look at each of these diagnostic processesthe steps you may go through to get your PCOS diagnosis.
Healthcare appointments for PCOS
During your appointment with your healthcare provider, they may ask about your symptoms, medications, and medical history. They may also ask whether anyone in your family, such as your mom, aunts, or sisters, experienced infertility or PCOS. This information can help them rule out other conditions besides PCOS.
During this appointment, be sure to inform your healthcare provider if you're trying to get pregnant since it may impact your PCOS treatment plan.
Physical exams for PCOS
During the physical exam, your healthcare provider may check your :
- Blood pressure
- Weight and Body mass index (BMI)
- Waist circumference
- Skin (if you have any acne or skin discoloration)
- Hair (patterns of excessive hair growth or hair thinning)
- Thyroid (feeling your gland on the front of your neck for any lumps or enlargement)
They may also perform a pelvic exam to rule out any growths, masses, or concerning changes in your vagina, cervix, uterus, ovaries, or fallopian tubes.
Using ultrasound PCOS diagnosis
Ultrasound uses sound waves to produce computer-generated images of your organs, tissues, and blood vessels. For example, during a pelvic ultrasound, a wand-shaped device, called a transducer, may be inserted into your vagina to get a picture with soundwaves of what your pelvic organs look like .
A transvaginal ultrasound will show whether or not you have any ovarian cysts or if your ovaries are enlarged. People with PCOS often have enlarged ovaries with many cysts . The ultrasonographer will also measure the thickness of your uterine lining (called the endometrium) during your transvaginal ultrasound. People with PCOS are at higher risk for precancerous changes in their endometrium (called endometrial hyperplasia) because they do not shed their uterine lining with monthly periods . The ultrasonographer will also look for pregnancies, polyps, fibroids, tumors, signs of cancer, signs of a pelvic infection, or other causes of your menstrual irregularities besides PCOS .
Note: There is debate among healthcare providers and medical researchers over the exact criteria to use to diagnose PCOS . Some providers may not require a transvaginal ultrasound showing polycystic ovaries (ovaries with cysts) if you have other symptoms of PCOS, such as irregular periods and blood test results indicating elevated androgen levels. Not all women with PCOS have ovarian cysts . Other providers want to rule out any other tumors by ultrasound before diagnosing PCOS.
Blood tests for PCOS
Lastly, your healthcare provider will order several blood tests. Blood tests measure hormone levels that might be abnormal if you have PCOS. Blood tests are typically conducted at healthcare providers' offices or third-party testing centers. However, you may be able to have certain blood tests at home (more on that below).
The blood tests most commonly used to diagnose PCOS are :
- Pregnancy test – Since pregnancy is one of the most common causes of amenorrhea (not getting your period), your healthcare provider will confirm that you are not pregnant first. Pregnancy tests measure human chorionic gonadotropin (hCG), a hormone your body makes once you become pregnant, in your blood or urine .
- Female hormones – Estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH)- are some. If you're not cycling regularly, checking these hormone levels can help your healthcare provider understand why. People with PCOS often have lower levels of FSH and higher levels of LH (called a serum LH to FSH ratio) . If this ratio is larger than two (levels of LH are at least two times higher than FSH levels), it is more likely that you have PCOS . Knowing your FSH level can also help rule out premature ovarian failure .
- Male sex hormones (androgens) – Since high levels of androgens are a part of PCOS, your healthcare provider will likely want to check your levels of total testosterone, androstenedione, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEA-S), and dihydrotestosterone (DHT) .
- Thyroid hormones – To make sure that a thyroid disorder is not causing your symptoms, your healthcare provider may check your levels of thyroid-stimulating hormone (TSH) and free T4. People with hypothyroidism may also have irregular menses with elevated levels of TSH and low levels of free T4 .
- Glucose – PCOS is associated with insulin resistance and diabetes . Over half of people with PCOS develop diabetes by age 40 . If you have PCOS, it may be harder for your body to regulate its blood sugar (called insulin resistance). A blood glucose test can show if you have high blood sugar levels and help your healthcare provider reduce your diabetes risk when choosing treatment options.
- Cholesterol and triglycerides – Cholesterol is a type of fat made by our bodies and is also found in the food we heat. High levels of cholesterol can increase your risk for cardiovascular disease. About 70 percent of people with PCOS have high levels of triglycerides (TG) and low levels of high-density lipoprotein HDL (good cholesterol) . So, your healthcare provider may also want to check your cholesterol levels with a blood test to determine your future risk for heart disease.
What are the Rotterdam Criteria for PCOS?
If your blood work, symptoms, and ultrasound report indicate that PCOS is the most likely cause of your symptoms, your healthcare provider may use something called Rotterdam Criteria officially diagnose your PCOS.
The Rotterdam Criteria were established in 2003 to standardize the PCOS diagnostic process . They recommend that clinicians diagnose PCOS diagnosis based on two of three of the following symptoms:
- Menstrual dysfunction (such as irregular or absent periods)
- Hyperandrogenism (such as excess hair growth or elevated androgen lab results)
- Polycystic ovaries (such as enlarged ovaries or multiple ovarian cysts)
How to treat PCOS
Once you receive a PCOS diagnosis, you have no doubt moved on to the next step: How to treat your PCOS symptoms. Your healthcare provider will customize your treatment to your symptoms, underlying health conditions, and desire to get pregnant .
If you are trying to get pregnant, your healthcare provider may recommend :
- Dietary changes – Since PCOS can be exacerbated by insulin resistance or being overweight, maintaining a lower-fat, lower-calorie nutritious diet can help.
- Lifestyle changes – Similarly, integrating regular exercise into your weekly routine can help you maintain a healthy weight and improve your fertility.
- Medications to induce ovulation – Since irregular menstrual cycles and infrequent ovulation result from PCOS, many people wonder, can you get pregnant with PCOS? Healthcare providers often turn to medications such as Clomiphene, Letrozole, or other gonadotropins (a type of fertility medication) to help you ovulate if you have PCOS .
- Diabetes medication – Metformin is a diabetes medication used to reduce insulin resistance which can have the side effect of improving fertility . Even if you don't have diabetes yet, metformin may be able to help your PCOS symptoms. Metformin can help some people with PCOS lose weight and start ovulating .
If you're not trying to get pregnant any time soon, your healthcare provider may instead suggest taking birth control pills . Hormonal contraceptives can help rebalance your hormones, regulate your menstrual cycle, and improve PCOS-induced acne and hair growth .
Your healthcare provider may also prescribe a medication called Spironolactone (Aldactone) to help temporarily reverse the effects of excess androgen . Just remember that this medication can cause birth defects, so only take it while also using a reliable method of birth control.
Everlywell: take control of your hormonal health today
Everlywell's easy-to-use at-home Women's Hormone Level Test enables you to take a comprehensive hormone panel from home. It can check your levels of the following biomarkers:
- Luteinizing hormone
- Follicle-stimulating hormone
- Thyroid-stimulating hormone
- Free T3
- Free T4
- Free testosterone
- Thyroid peroxidase antibodies
Once you send in your blood and saliva samples, we'll have them tested at a CLIA-certified laboratory and reviewed by an independent board-certified physician in your state. You can expect to receive your results within a few days. Then we'll send your results to your device securely using our HIPAA-compliant system. Once you receive your results, you can share them with your healthcare provider and develop the best treatment plan for you.
Can you get pregnant with PCOS?
How to lower estrogen: what you need to know
What causes low estrogen levels?
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