Investigations and Diagnosis of PCOS

Although there is some controversy regarding the diagnosis of PCOS, international guidelines for the assessment and management of PCOS endorse the Rotterdam 2003/4 criteria.

Diagnosis of PCOS in adults requires at least two of the following three clinical features (1):

  • Oligoovulation or anovulation (usually manifested as oligomenorrhea or amenorrhea) (1). Anovulation is the leading cause of secondary amenorrhea in people with PCOS attending fertility clinics (8). Irregular menstrual cycles are defined as <21 or >35 days, or less than eight cycles per year for people over three years post menarche to perimenopause (1).  
  • Clinical and/or biochemical signs of hyperandrogenism.
  • Polycystic ovaries on ultrasound.

The table below outlines the pathway of investigations as advised by the National Institute for Health and Care Excellence (NICE), 2018 (7).

Table 1: Investigations for the Diagnosis of PCOS

Investigation

Normal Range

Outcome Measures

Measure total testosterone

12.4 to 15.8ng/dL (9)

Normal to moderately raised

Measure sex hormone-binding globulin (SHBG)

Females ≤50 years: 19-145 nmol/L

 

Females ≥ 50 years: 14-136 nmol/L (10)

Normal to low

Free androgen index (the measurement of active testosterone).

< 5 (7)

Normal to moderately raised

Measure luteinizing hormone, (LH), follicle-stimulating hormone (FSH), LH/FSH ratio, thyroid-stimulating hormone (TSH)

LH/FSH ratio: < 3 (4)

 

TSH: 0.4–4.5 mU/L (7)

To exclude other causes of oligomenorrhea and/or amenorrhea

Prolactin

<500 mU/L (7)

Mildly elevated

Ultrasound

 

Polycystic ovaries are defined as the presence of 12 or more follicles in at least one ovary (measuring 2–9 mm diameter) or increased ovarian volume (greater than 10 cm3).

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