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How is PCOS diagnosed?

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3 fertility expert(s) answered this question

Answer from: Kate Davies, RN, BSc (Hons), FP Cert

Nurse, Independent Fertility Nurse Consultant & Coach at Fertility Industry Consultancy & Podcast Co-Host
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​I​deally, PCOS should be diagnosed based on three criteria and these criteria are called the Rotterdam Criteria. The first criteria is that you either have no periods or you’re having irregular periods. The second criteria is that you have cysts on your ovaries on scans so they can be seen on a scan. The third one is that you either have a raised androgens level, raised testosterone levels on a blood test, or you have symptoms of the raised androgens. That can be things like excess body weight, acne, excess bodily hair or thinning of hair on your scalp. To have a diagnosis, using the Rotterdam Criteria, you just need to have two, so you could still have cysts on your ovaries and have irregular periods but your testosterone level would be normal and you’d still have a diagnosis of PCOS. Or you could for example have irregular periods and raised testosterone, but on scan you don’t currently have any cysts on your ovaries. So it’s really important that you ask your doctor to assess you based on the Rotterdam criteria, get the three criteria looked at and you only need two to have that diagnosis.

Answer from: Moses Batwala

Gynaecologist, Clinical Director, Consultant Gynaecologist and Fertility Specialist Sims IVF
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What they call the Rotterdam criteria, so traditionally to diagnose a woman with a polycystic ovarian syndrome we’d say they need to satisfy at least two of three criteria and those three criteria that we want them to fall into to have at least two signs of are:
1. That the woman has irregular periods and that it could be irregular that they’re prolonged or even absent completely -that’s the first one that the woman should have either irregular or absent periods.
2. She should have signs either physical or metabolic signs of raised androgens and when I say physical she should have increased facial hair or male pattern facial hair women who have kind of like a bit of a stubble on their chins or on their cheeks or male pattern baldness on their heads or some of them even develop what they call an Adam’s apple, if their androgens are that high or if you do a blood test on them, you find that they have signs of a low sex hormone binding globulin or even a raised testosterone above what is the normal testosterone level for a woman. So that’s the second group and lastly:
3. The third sign is signs of polycystic ovaries on ultrasound scan and normally doing an ultrasound scan on a woman, you can count what are called the Antral Follicles on each ovary and the normal number of showing a good ovarian reserve in a woman is – if she has anywhere between 6 to 12 follicles on each ovary. With a polycystic ovary, there will be an excess of 12 follicles on each ovary, giving her an excess of plus 20 a total Antral follicle count of more than 24. so as long as a woman has two out of those three criteria, she’s then classified as as having polycystic ovarian syndrome however I should also add that Polycystic Ovarian Syndrome is also a diagnosis of exclusion: you have to rule out other hormonal causes of a woman may have these symptoms such as maybe she has an adrenal tumor or a thyroid disorder or a pro disorder of the pituitary gland – so those things also have to be ruled out before you make a diagnosis of Polycystic Ovarian Syndrome.

Answer from: Halyna Strelko, MD

Gynaecologist, Co-founder& Leading Reproduction Specialist IVMED Fertility Center
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This time that approach is to do hormonal levels to see FSH, LH, testosterone, estrogens also exclude problem with high prolactin level and problem with steroids because sometimes they can also give the disturbance of cycle, also necessary to do ultrasound to see the appearance because sometimes PCOS patients has some specific sign like hirsutism – it means the growth of hair in place where normally a woman has no hairs like face, like breasts, like abdomen hands and this is necessary to detect. It is a sign of high androgen levels. Also necessary to test androgens as well and also necessary to see if there is some problem with glucose level because more often PCOS patients have diabetes of type 2, insulin independent diabetes or some insulin resistance so sometimes it may be not normal. Necessary to see all that and if we found every two from three signs: an ovulation, androgen excess and PCOS appearance – every two from these three, we have the right to say that these patients have PCOS.

About this question:

Is PCOS easy to diagnose?

How is PCOS being diagnosed? What are the criteria to determine PCOS? Are there levels of severity of PCOS?

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