DIAGNOSIS OF PCOS
There is no single test to diagnose PCOS. Diagnosis will usually be made by considering the following:
- your symptoms
- the results of hormone testing including male hormone levels (testosterone, SHBG and the free androgen index or FAI), and tests to rule out other hormonal problems
- an ultrasound to look for cysts and enlargement of the ovaries (but this isn’t necessary to make the diagnosis and isn’t recommended in teenage girls)
Many women go for a long time without being diagnosed with PCOS as they don’t consider their symptoms to be related, and seek treatment for them one at a time. These symptoms might include irregular periods, infertility, acne, hirstuism or weight gain and difficulties with weight loss.
According to current guidelines you must have two out of three of the following to be diagnosed with PCOS:
- Oligo- or anovulation (this means irregular or absent menstrual periods).
- Clinical and/or biochemical signs of hyperandrogenism (this means high levels of male hormones on a blood test or signs of increased male hormone levels such as acne and excess hair).
- Polycystic ovaries (seen on ultrasound)
Other conditions which might cause similar symptoms to PCOS such as congenital adrenal hyperplasia, androgen-secreting tumours and Cushing’s syndrome need to be ruled out.
While testing for insulin resistance is not part of these guidelines, many doctors will also do a Oral Glucose Tolerance Test (OGTT) to test for high insulin levels, which are commonly seen in women with PCOS. Due to the increased risk of type 2 diabetes associated with PCOS, best practice guidelines recommend that all women with PCOS are screened for diabetes every 2 years with a OGTT, or yearly if they have other risk factors for diabetes.