PCOS is a diagnosis of inclusion and exclusion. There is not a specific test that can be used to diagnose PCOS and there is not widespread agreement on what the diagnostic criteria should be. A woman's doctor will do tests to rule out other causes of anovulation and infertility. He will usually order a variety of hormone tests to help determine whether the symptoms are due to hormone overproduction as seen in PCOS, an adrenal or ovarian tumor, or an overgrowth in adrenal tissue (adrenal hyperplasia). Ultrasounds are often used to look for cysts in the ovaries and to see if the internal structures appear normal.
A doctor will evaluate a combination of laboratory results and clinical findings that suggest PCOS. If a woman is diagnosed with PCOS, her doctor may order tests such as lipid profiles and glucose levels to evaluate and monitor the risk of developing future complications such as diabetes and cardiovascular disease.
- FSH (Follicle Stimulating Hormone) - will be normal or low with PCOS
- LH (Lutenizing Hormone) - will be elevated
- LH/FSH ratio - This ratio is normally about 1:1 in premenopausal women, but with PCOS a ratio of greater than 2:1 or 3:1 may be considered diagnostic.
- Prolactin - will be normal or low (elevated in hyperprolactinemia)
- Testosterone - total and/or free; usually elevated
- DHEAS - frequently mildly elevated with PCOS; may be done to rule out a virilizing adrenal tumor in women with rapidly advancing hirsutism
- Estrogens - may be normal or elevated
- Sex hormone binding globulin (SBGH) - may be reduced
- Androstenedione - may be elevated
- hCG (Human chorionic gonadotropin) - used to check for pregnancy; negative unless pregnant
- Lipid profile (low HDL, high LDL, and cholesterol, elevated triglycerides)
- Glucose - fasting and/or a glucose tolerance test; may be elevated
- Insulin - often elevated
- TSH (Thyroid stimulating hormone) - to check thyroid function
- Free Cortisol and Creatinine levels - rule out Cushing syndrome
- 17-hydroxyprogesterone - to rule out congenital adrenal hyperplasia
- IGF-1 - to rule out acromegaly
A pelvic ultrasound (transvaginal and/or pelvic/abdominal) is used to evaluate enlarged ovaries. With PCOS, the ovaries may be 1.5 to 3 times larger than normal and characteristically have more than 12 or more follicles per ovary measuring 2 - 9 mm in diameter. Often the cysts are lined up on the surface the ovaries, forming the appearance of a "pearl necklace." The follicles tend to be small and immature, thus never reaching full development. The ultrasound helps visualize these changes in more than 90% of women with PCOS, but they are also found in up to 25% of women without PCOS symptomology. (See Radiologyinfo.org: Pelvic ultrasound)
Laparoscopy may be used to evaluate ovaries, evaluate the endometrial lining of the uterus, and sometimes used as part of surgical treatment. (See MedlinePlus: Pelvic laparoscopy)