From the Guidelines
Diagnosing PCOS requires a comprehensive approach involving medical history, physical examination, and laboratory tests, with at least two of three key criteria present: irregular or absent menstrual periods, elevated androgen levels, and polycystic ovaries on ultrasound, as confirmed by the most recent study in 2024 1. To diagnose PCOS, healthcare providers should follow a step-by-step approach:
- Begin with a detailed medical history focusing on menstrual patterns, fertility concerns, weight changes, and symptoms like hirsutism or acne.
- Perform a physical examination to check for signs of androgen excess and measure vital signs, including BMI.
- Conduct blood tests to measure hormone levels, including testosterone, DHEAS, LH, FSH, estradiol, prolactin, and thyroid function tests.
- Use transvaginal ultrasound to examine ovarian appearance and follicle count, with a threshold for polycystic ovary morphology (PCOM) of a follicle number per ovary of ≥20 and/or an ovarian volume ≥ 10ml, as recommended by the 2024 study 1.
- Consider additional metabolic screening, such as glucose tolerance tests and lipid profiles, to assess the risk of diabetes and cardiovascular disease.
- Rule out other conditions with similar symptoms, such as thyroid disorders, hyperprolactinemia, or congenital adrenal hyperplasia. The 2024 study 1 confirms that FNPO is the most accurate ultrasonographic marker in the diagnosis of PCOS in adults, with OV and FNPS as alternatives when accurate total follicle counts are not possible. It is essential to standardize best practices in follicle counting to ensure accurate measurements across users, settings, and technology, as highlighted in the 2024 study 1 and the 2019 review 1. Early diagnosis is crucial, as PCOS requires ongoing management to prevent long-term complications like diabetes, heart disease, and endometrial cancer, as emphasized in the 2020 guideline 1.
From the Research
Diagnostic Criteria for PCOS
To diagnose PCOS, the following criteria are considered:
- Menstrual cycle and endocrine dysfunction with hyperandrogenism, as stated in the Rotterdam criteria 2
- The presence of polycystic ovaries on ultrasound, although this is no longer a required criterion for diagnosis 2
- The exclusion of other disorders that may cause similar symptoms, such as congenital adrenal hyperplasia, androgen-secreting tumors, and Cushing's syndrome 3
Clinical Manifestations of PCOS
PCOS is characterized by a range of clinical manifestations, including:
- Hirsutism, which is excessive hair growth on the face, chest, and back 2
- Infertility, which is often due to anovulation or irregular ovulation 2
- Acne, which is often severe and resistant to treatment 2
- Weight gain, which can increase the risk of developing insulin resistance and type 2 diabetes 2
- Hyperandrogenism, which is characterized by elevated levels of androgens such as testosterone 4
Laboratory Tests for PCOS
Several laboratory tests can be used to support a diagnosis of PCOS, including:
- Hormone tests, such as measurements of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) 4
- Tests for insulin resistance, such as glucose tolerance tests or measurements of insulin levels 5
- Tests for androgen excess, such as measurements of testosterone or dihydrotestosterone (DHT) 4
Importance of Early Diagnosis
Early diagnosis and treatment of PCOS are essential to prevent long-term complications, such as:
- Infertility and pregnancy-related complications 2
- Insulin resistance and type 2 diabetes 2
- Cardiovascular disease and stroke 2
- Endometrial hyperplasia and cancer 2 Nurse practitioners play a crucial role in educating patients about the importance of early diagnosis and treatment, as well as providing comprehensive care and management for patients with PCOS 6