PCOS 101

Part Two: Getting a Diagnosis

In Part One we discussed the physical changes and symptoms of PCOS.  Today will talk about the very real challenge of making a diagnosis of PCOS.  Why is it so difficult?

First, PCOS is a clinical diagnosis, which means the doctor should take into account the details of the woman’s symptoms and physical signs of PCOS and then use his or her experience and judgement to decide if the woman has PCOS.  

There is no one test that confirms a woman has or does not have PCOS.  It is a common misconception that a woman must have cysts in the ovaries to have PCOS, but this is not true.  A woman need only have irregular periods and high male hormone levels to meet the criteria for diagnosis. 

PCOS is also a “diagnosis of exclusion.”  This means the doctor should rule out other potential diseases that have similar symptoms before making a diagnosis.  There are two rare diseases that should be ruled out before diagnosing PCOS–Cushing’s Syndrome and Congenital Adrenal Hyperplasia.  For the sake of time and space I will not discuss those diseases today.

Women can be diagnosed with PCOS when their doctor notes that they have physical signs and symptoms, and lab results that are consistent with PCOS, and cannot find another cause. A large number of women meet these criteria.  One woman with PCOS may look and feel one way and another may look and feel completely differently.  Do they have the same disease? Or, more likely, do they have a variety of issues that cause the same symptoms?

Because it is up to the doctor to decide a woman has PCOS, it is not unusual for doctors to disagree about whether a particular patient does in fact have it. Despite having seen hundreds of women with PCOS, I am not 100 percent sure of the diagnosis in some cases. On average women have seen three providers before receiving a diagnosis, but some have seen many many more all while suffering with very real symptoms. 

When you see your doctor with symptoms of PCOS, you can expect your doctor to ask you about the frequency and pattern of your periods.  They will examine you for signs of high male hormone levels like acne and body hair growth.  And they will draw blood to look for signs of high male hormone levels and insulin resistance as well as to confirm that you do not have any other diseases.  

Once the diagnosis is made, it is time to think about treatment options.  We will review the common treatments for PCOS symptoms in Part Three.

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