How Is PCOS Diagnosed? A Step-by-Step Walkthrough of the Assessment Process

Your period ghosted you. Acne is making your skin its permanent home. You can't control the weight scale despite diet and exercise.

Dr. Google might say it's PCOS, aka polycystic ovary syndrome. 

But how do you actually confirm it? Is it a blood test or an ultrasound? How will your doctor find it out? 

Well, to your surprise, "there's no single PCOS test or scan" that accurately diagnoses the condition. It’s essentially a step-by-step medical process that rules out other conditions first — what doctors call a ‘diagnosis of exclusion’ — and then checks whether your symptoms meet the internationally accepted criteria for PCOS. 

Confused or worried? Please don't. This approach is science-backed and approved by leading organizations like The International PCOS Network and the Endocrine Society. And once you know what to expect, it feels a lot less overwhelming. 

So, without wasting another minute, let's talk about it. 

Think You Know PCOS? Probably Not 

Polycystic ovary syndrome, or PCOS, isn't just 'cysts on the ovaries'. It's a complex hormonal imbalance that affects your skin, weight, and even your ovulation cycle.

• Elevated levels of androgens (male hormones) 

• Disrupted levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) 

*FSH and LH are essential for sexual development and reproductive cycles. 

And, it's way more common than you can think, affecting millions of women (6-13%) of reproductive age, posing a risk to fertility. What's worse? PCOS cases and prevalence are increasing every day. Thanks to: 

• Sedentary lifestyle (lack of exercise, longer screen sitting times) 

• Stress among women (women are more likely to experience anxiety and depression than men) 

• Unhealthy diet (junk foods and processed sugars) 

• Rising metabolic imbalance (like diabetes, obesity, insulin resistance, and so on) 

The timely PCOS diagnosis opens the doors to multiple treatment options and better symptom control. The sooner you identify, the better your chances of preventing long-term complications.

Read More: A Guide to Normal Testosterone and Estrogen Levels in Women

PCOS Diagnosis Process: 6-Steps Medical Approach

Despite the awareness and medical advancements, about 70% of affected women are unaware they have PCOS (as per the WHO). Results? Greater pregnancy complications and health risks. Here's what it takes to diagnose PCOS medically: 

Step 1: First, Your Doctor Will Ask About the 'Signs' 

Once you walk into the clinic to confirm the PCOS condition, your doctor will start by asking about symptoms and patterns you've noticed. Expect questions like: 

• How regular are your menstrual cycles? 

A primary indicator of PCOS is less frequent periods (or none at all). Fewer women also experience heavy bleeding or longer periods. 

• Have you noticed increased facial or body hair growth? 

Due to hormonal imbalance, PCOS can cause excessive unwanted hair (hirsutism) on the face, chest, back, or abdomen. 

• Any persistent acne or hair thinning? 

High androgen levels can lead to baldness in women and activate the sebaceous glands, which increases oil production, causing acne. 

• Are you experiencing weight changes? 

Women with PCOS often develop insulin resistance. The result? Sudden weight gain—especially around the abdomen—and an inability to lose weight, even with regular exercise and dietary changes.

• Any issues with fertility? 

The regular ovulation in PCOS makes it difficult for women to conceive naturally. Many cycles are even anovulatory where ovulation is not happening at all. In simpler terms; No ovulation= no conception.

• Has someone in your family (mother or grandmother) had PCOS before? 

Because polycystic ovary syndrome has a strong genetic component, it tends to run in families (not necessarily, but high chances). 

Be honest with your answers and explain everything about symptoms with clarity, their severity, frequency, and how long since you've noticed them.

Also Read: The Top 5 Hormonal Changes You Experience After 35

Step 2: A Quick Physical Checkup for Visible Ques 

After hearing your story, your doctor will likely do a thorough physical examination. They'll check for your: 

1. Body mass index (BMI) 

2. Blood pressure and heart rate 

3. Extra hair growth, scalp thinning, and skin discoloration 

Additionally, be ready for a pelvic test, the primary physical test of PCOS.

Pelvic Test in PCOS 

During a pelvic exam/test, your doctor will examine your reproductive organs (both internal and external) to observe any masses, growths, or other changes. It can be similar to your regular examination or a little extra (depending on your conditions). It involves: 

• Visual Inspection: Where the doctor looks for any signs of excess hair growth or skin changes in the external genitalia. 

• Bimanual Exam: The Doctor will insert gloved, lubricated fingers into the vagina and observe the abdomen to feel the size and shape of the uterus and ovaries. 

• Speculum Exam: Though rare, in some cases, a device (called a speculum) is used to open the vaginal walls gently. It gives the doctor a better view of the vaginal canal and cervix. 

Read More: What to Know About Female Sex Hormones

Step 3: Lab and Blood Tests to Measure Your Hormone Levels 

Once your doctor has a good overview and physical exam results, they'll likely order blood tests to see what's happening inside your body. 

Given below is a table compiling common lab tests included in PCOS diagnosis: 

Additionally, based on your medical history, your doctor may recommend insulin and thyroid testing. Often, fasting insulin and fasting glucose are used to calculate something called the HOMA-IR score, which helps indicate whether insulin resistance is present. These tests alone can’t confirm PCOS — the results are always interpreted alongside your symptoms and clinical signs. 

If you're confused about the number, ask your doctor for an explanation and the reasons behind it. 

Step 4: Ultrasound to Check Your Ovaries (If Required) 

Though not necessary, in certain cases, the doctor may recommend an ultrasound to visualize the ovaries and to get a better picture of uterus to rule out other conditions:

The ultrasound helps to check for: 

• Ovarian size: PCOS ovaries can be larger than average. 

• Follicle count: Finding 20+ small follicles in one ovary may indicate polycystic ovaries. 

• Ovarian texture: In PCOS, ovaries often appear together, resembling the "string of pearls" pattern. 

Ultrasound isn't always conclusive, especially in teens (in teenage years, polycystic ovaries can appear without the syndrome). That's why doctors rarely recommend an ultrasound, but usually include it after symptoms and lab results.

Pro tip: Schedule your ultrasound in the first half of your menstrual cycle (days 3–7) for the most accurate follicle count.

Also Read: Difference Between Discharge Before Period vs. Early Pregnancy

Step 5: Ruling Out Other Possible Health Risks 

One of the most complex parts of PCOS diagnosis is ensuring something else isn't causing your symptoms. Certain hormonal conditions can almost mimic PCOS, including:  

• When the thyroid gland can't produce or release sufficient hormones (hypothyroidism or hyperthyroidism) 

• High prolactin (a hormone responsible for milk production) levels 

• Excess cortisol (stress hormone) production, also called Cushing’s syndrome 

A professional doctor can correctly diagnose your medical condition, recommending the right treatment and medication. 

Step 6: Matching Your Results to the Official PCOS Checklist 

Here comes the final step, matching your results with the official PCOS criteria to find your current health conditions. 

Now, doctors follow international guidelines (which redefine the longstanding Rotterdam criteria) to diagnose PCOS. You may be diagnosed with PCOS if you have at least two of the following three signs, and also if your physician rules out your symptoms based on other differential diagnosis:

1. Your body is making high levels of male hormones (like testosterone). Checked through blood tests and symptoms like unwanted facial hair, bad acne, or male pattern baldness. 

2. Your period cycles are irregular. Mainly, when the gap between two ovulations is more than 35 days, or if you experience fewer than 8 periods a year. 

3. Confirmation of polycystic ovaries. Currently, NIH red flags 20 or more follicles in one ovary or having an ovary larger than 10 cubic centimeters. Or, you have elevated anti-Müllerian hormone (produced by the ovaries).

Remember, the one sign alone is never conclusive. 

What to Expect After PCOS Diagnosis 

If your doctor diagnoses you with PCOS, it's not the end of the story, but the beginning of the journey. With the right treatment and approach, you can manage PCOS. Here's what you can expect throughout the management plan: 

1. Tailored Medical Treatment 

Personalized medication and supplementation plan to target your main concerns (regulating periods, improving fertility, or managing symptoms). 

2. Lifestyle Changes That Actually Work 

You might hear this a lot, but targeted lifestyle adjustments can actually improve PCOS symptoms. For example: 

1. Refined sugars and junk foods can worsen insulin resistance. 

2. Foods like berries and fatty fish can reduce cellular inflammation. 

3. Balancing carbs with protein and fiber can help balance insulin sensitivity. 

4. Strength training, cardio, and regular exercise can improve insulin sensitivity which in turn speed up metabolism and burn off hormonal belly fat. 

5. Adequate hydration and quality sleep help balance mood fluctuation and energy levels. 

6. Reduce exposure to endocrine disruptors (chemicals that mimic hormones) to balance hormones. 

3. Regular Monitoring 

PCOS isn't a "treat it once and forget it" disorder. It demands periodic check-ins, lab tests, and sometimes ultrasounds to track progress and spot any other risks. 

Moreover, in severe cases, the doctors often do additional tests to monitor your: 

• Blood glucose levels 

• Lipid profiles 

• Insulin levels 

Why? PCOS often disrupts the natural balance and increases the risk of related chronic conditions. 

Bottom Line 

That's how experts diagnose PCOS. Though it is complex, it is a safe and proven approach (especially when you choose professional doctors). 

The real journey starts after diagnosis. Don't hesitate. If you're in doubt or uncertain: 

• Watch for the symptoms 

• Make an appointment with your gynecologist or trusted doctor 

• Go through the recommended tests 

• Ask questions and understand what your body is experiencing. 

Remember, PCOS can really look different from one woman to another. Stay aware and avoid myths. Your symptoms, your journey, and your treatment are always uniquely yours. 

Frequently Asked Questions (FAQs) 

Q1. Can I diagnose PCOS at home? 

No, only professional medical experts can accurately diagnose PCOS. However, at home, you can watch for related symptoms like unexplained belly fat, unwanted hair growth, scalp thinning, irregular periods, and skin discoloration. 

Q2. What is the diagnostic process for PCOS? 

PCOS is diagnosed if you have any two of these three symptoms: 

• Signs of high male hormones 

• Irregular or few periods 

• Polycystic-looking ovaries on an ultrasound, after ruling out other causes. 

Q3. Can I get pregnant with PCOS? 

For some women conceiving is difficult but with the right nutrition and support you can have seamless conception.

Q4. Can I lose weight with PCOS? 

Yes, through necessary dietary changes, nutritional guidelines, and exercise, you can lose weight in PCOS. Also, this weight loss can significantly improve the symptoms and quality of life among affected women. 

Q5. What are the three tests for PCOS? 

Physical examination (mainly pelvic test), blood test (to check hormonal levels), and ultrasound for polycystic ovaries are the three major tests included in PCOS diagnosis. 

 References:

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2. World Health Organization. Polycystic ovary syndrome (PCOS). WHO Newsroom Fact Sheets. 7 February 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome 

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8. Dason ES, Koshkina O, Chan C, et al. Diagnosis and management of polycystic ovarian syndrome. CMAJ. 2024 Jan 28;196(3):E85–E94. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10833093/