Diagnosis of Polycystic Ovary Syndrome

Diagnostic Testing for Polycystic Ovary Syndrome

Medical History

The first step in the diagnostic process is an in-depth medical history taken by the health care provider. The procedure for diagnosing an adolescent is similar to that of a woman with suspected PCOS. Some issues that are evaluated during the medical history include:

  • Any family history of oligomenorrhea, amenorrhea, hirsutism and infertility
  • Family history of diabetes
  • History of menstrual irregularities and when they started.
  • Onset of hirsutism - sudden or gradual onset
  • Medication history - some medications can cause hirsutism (e.g. antiepileptics and corticosteroids)
  • General health - diet, exercise, smoking, and alcohol use

Physical Examination

In the course of the physical examination, the health care provider may look for the following:

  • Signs of alopecia (balding) or presence of hair around the temples
  • Hair in places not commonly found on women, (e.g., upper lip, chin, chest, back, abdomen, upper arms and thighs).
  • Presence and severity of acne
  • Signs of metabolic syndrome (obesity, hypertension)
  • Signs of acanthosis nigricans
  • Clitoromegaly (enlargement of the clitoris) and/or ovarian enlargement on pelvic examination

Laboratory Evaluation

Polycystic ovary syndrome is generally a diagnosis of exclusion. There is no single test that determines the diagnosis of PCOS. Blood tests are used in order to rule out other possible underlying conditions as well as to create a biochemical profile that may be compatible with the presenting physical symptoms to reach a diagnosis of PCOS.

Laboratory values that are examined include:

  • Fasting glucose and insulin levels.

  • Glucose tolerance test to evaluate the presence of insulin resistance. This test measures the body's ability to process sugar. The most common test is a blood test after fasting at least 8 hours. The American College of Obstetricians and Gynecologists (ACOG) recommends that all women with suspected PCOS be tested for Type II diabetes and glucose intolerance with a fasting and two-hour blood sugar after a 75 gm glucose load.

  • Leuteinizing hormone (LH)

  • Follicle stimulating hormone (FSH)
  • Free testosterone levels
  • Dehydroepiandrosterone sulfate level (DHEAS)
  • Prolactin levels
  • Thyroid stimulating hormone (TSH) - some women with PCOS have under-active thyroid.
  • Lipid and lipoprotein studies - cholesterol, LDL, HDL, triglycerides
  • Sex hormone binding globulin SHBG

Laboratory value changes may be subtle and the diagnosis of PCOS may be based on a pattern of laboratory test results that are indicative of PCOS rather than on the results of individual laboratory tests. Often, a diagnosis cannot depend solely upon biochemical markers since women with PCOS may fall within the normal range of values on many of these tests. For example, approximately 40% of women with PCOS have normal levels of leuteinizing hormone (LH).

Transvaginal Ultrasound

Transvaginal ultrasound imaging (sonogram) is useful for demonstrating the presence of the classical polycystic ovaries that are characteristic of women with PCOS. Ultrasound, however, cannot be used to make a definite diagnosis of PCOS because polycystic ovaries can be associated with several conditions other than PCOS and can also be demonstrated by ultrasound in in up to 25% of otherwise normal women.