By Dr. Sharon R. Hontiveros
In adults, diagnosis generally requires at least two of the following three features, after excluding other causes:
1. Irregular or absent menstrual cycles
Infrequent periods can reflect irregular ovulation. From three years after the first period, cycles shorter than 21 days, longer than 35 days, or fewer than eight periods yearly warrant assessment.
2. Signs or blood-test evidence of excess androgens
Excess facial or body hair may be a sign. Blood tests can identify elevated testosterone or related hormones. Androgens are naturally present in women too.
3. Polycystic ovarian appearance
With suitable modern ultrasound, 20 or more follicles in at least one ovary can meet the adult imaging criterion. With older equipment or limited image quality, ovarian volume of at least 10 mL may be used. Interpretation depends on the scan.
In adults, appropriately interpreted AMH testing can sometimes replace ultrasound, but cannot diagnose PCOS by itself.
What else should you know?
Polycystic ovaries alone do not confirm PCOS. When irregular cycles and excess androgens are already present, ultrasound is not necessary for diagnosis.
Adolescent criteria differ: both persistent menstrual irregularity and excess androgens are required; ultrasound and AMH are not recommended for diagnosis.
Your doctor will consider other explanations, including thyroid dysfunction and high prolactin. PCOS can be associated with difficulty conceiving and increased risk of type 2 diabetes, but symptoms and needs vary.
A diagnosis helps guide care for your cycles, fertility goals, metabolic health, and emotional wellbeing. As your OB-GYN, I’m here to help you understand the findings and plan your next steps.
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