Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that affects approximately 10% of women of reproductive age, characterized by a combination of symptoms that may include irregular menstrual cycles, excessive hair growth, acne, and obesity. Due to its varied presentation, diagnosing PCOS can be a multifaceted process.

Initial Consultation

The diagnostic process typically begins with a detailed medical history. Doctors will ask about menstrual cycles, changes in weight, growth patterns of hair, and any previous diagnoses of related issues like diabetes or metabolic syndrome. A family history of PCOS or related hormonal disturbances is also crucial as PCOS can have a genetic component.

Physical Examination

A physical examination includes checking for signs of excess androgen activity such as acne, hair growth patterns (hirsutism), and alopecia (hair loss). The doctor may also assess body mass index (BMI) and waist circumference, as obesity is commonly associated with PCOS but not present in all cases.

Laboratory Tests

Blood tests play a pivotal role in diagnosing PCOS. These may include:

• Hormonal Analysis: Levels of hormones such as luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogen, and testosterone (including free testosterone) are measured. Women with PCOS often have elevated levels of LH and testosterone.
• Glucose Tolerance Tests: These are conducted to assess insulin resistance, a frequent concern in PCOS cases.
• Lipid Profile: Checking cholesterol and triglycerides can help evaluate cardiovascular risk, which is heightened in women with PCOS

Ultrasound

A transvaginal ultrasound may be performed to examine the ovaries and the thickness of the endometrium (lining of the uterus). In PCOS, the ovaries may appear enlarged and contain numerous small follicles. Although not present in all cases, the appearance of polycystic ovaries on ultrasound can support the diagnosis. 

Exclusion of Other Disorders

It’s crucial to exclude other conditions that mimic PCOS symptoms, such as thyroid dysfunction, congenital adrenal hyperplasia, Cushing's syndrome, and tumors that produce androgens. A thorough assessment ensures that symptoms are not attributable to other underlying conditions.

Rotterdam Criteria

The Rotterdam criteria are commonly used to diagnose PCOS. According to these criteria, at least two of the following three features must be present:

1. Irregular Ovulation or Anovulation: Infrequent or prolonged menstrual periods or the absence of ovulation.
2. Clinical or Biochemical Signs of Hyperandrogenism: Excessive hair growth, acne, or elevated androgen levels.
3. Polycystic Ovaries: The presence of 12 or more follicles in one or both ovaries or increased ovarian volume.

Using a combination of medical history, physical examination, laboratory tests, and imaging, physicians can accurately diagnose PCOS. This comprehensive approach helps tailor an effective management and treatment plan for each individual.