Diagnosis of PCOS

Getting a diagnosis for polycystic ovary syndrome can be part of the battle with this disorder as often the typical PCOS symptoms do not seem to be related to each other, at least initially. This is why there are a number of steps involved when you are looking to for a PCOS diagnosis. In addition to a regular check-up and physical exam, your health care provider will likely also want to order some blood tests and perform an ultrasound.

The Check Up


When you meet with your doctor, she will conduct a physical exam during which time any outward PCOS symptoms you may have, such as acne or excessive facial hair, will be assessed. Additionally, your doctor will ask you questions about your medical history and reproductive health. Typical questions can include:

  • Your menstrual history: When did you start your period? How often do you have your period and how long is it? Do you experience irregular periods? Are your periods heavy?
  • Your reproductive history: Have you ever been pregnant? Have you suffered a miscarriage or had an abortion? Do you currently use or have you have use birth control? What kind?
  • Your family history: Has anyone in your family ever been diagnosed with a reproductive problem or infertility? Does anyone else in your family suffer from PCOS?

Based on your answers and your outward symptoms, your healthcare provider will then decide whether to investigate the issue further through the use of blood tests and ultrasounds.

Blood Tests
A couple of blood tests will assist in making the diagnosis - one to check the level of androgens, such as testosterone. Another test will measure the hormones involved in egg development - in PCOS there is a characteristic rise in leutenising hormone (LH). A progesterone blood test 7 days before your expected menstrual period can check if you are ovulating. Prolactin levels may also be checked. But it is not just the presence of a hormone imbalance that your health care provider should be looking for.

Since polycystic ovarian syndrome is so heavily associated with insulin resistance, you can also expect to have your blood tested for fasting glucose and insulin levels. In some cases, though, blood tests may show that your glucose levels are normal, in which case you may be asked to do an oral glucose tolerance test (OGTT) to double check that everything is actually fine. This test is useful in identifying underlying insulin resistance issues even when a glucose fasting test has come back normal.

Finally, your cholesterol levels may also be assessed. Women with PCOS often have high LDL cholesterol levels, which is the "bad" type of cholesterol. Since having high LDL cholesterol has been linked with heart disease, it is a good idea to make sure your cholesterol levels are healthy.

An ultrasound scan showing multiple small cysts around the edge of the ovary

Ultrasound


Ultrasound is usually done as an internal scan, meaning a small ultrasound probe is placed just inside the vagina, giving the best views of the ovaries and pelvic organs. In PCOS, the ovaries are found to have multiple, small cysts around the edge of the ovary. These cysts are only a few millimetres in size, do not in themselves cause problems and are partially developed eggs that were not released. Women polycystic ovaries, though, may have ovaries that are between one and half to three times large than cyst-free ovaries.

It is important to note that, just because you have cysts on your ovaries, does not necessarily mean you have PCOS. It is actually extremely common for women to have cysts on their ovaries. However, in PCOS, the number of cysts can be quite high, which is why these women experience reproductive problems. Despite this, not all women with PCOS will be found to have cysts on their ovaries. This is why a diagnosis will be based on all the symptoms that present themselves: hormonal imbalances, evidence of insulin resistance, skin problems, fertility issues, menstrual irregularities and ovarian cysts.

What is the Difference Between PCO and PCOS?


The term 'polycystic ovaries' describes the ovaries, as seen on the ultrasound scan above. Many women have ovaries that are polycystic, but do not have any of the other symptoms or hormone findings as described previously.

Overall, around 20% of women of the general population have ovaries with this appearance, and what isn't known yet from current research is whether this is one end of a long scale including the full polycystic ovary syndrome or a sign that symptoms are more likely to develop in the future.

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