Polycystic Ovary Syndrome (PCOS) is a multifactorial condition that affects many areas of a woman's life. The exact cause of PCOS has not yet been identified, but genetic and epigenetic factors (i.e., the influence of our environment, our lifestyle, the people we associate with, etc.) have been identified. There are several criteria used to diagnose a woman with PCOS.

Often confused with other disorders or underlying causes, in this article we explore the main diagnostic criteria for PCOS:

1. Clinical criteria for PCOS
2. Hormonal markers to investigate in PCOS
3. Metabolic parameters in PCOS
4. Ultrasound for the diagnosis of polycystic ovary syndrome
5. Conclusions on PCOS diagnosis

1. Clinical criteria for PCOS

   In 2003, the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) published the Rotterdam Criteria, later updated in the 2023 PCOS guidelines.[1].

   Currently, these are the most widely used and reliable international criteria for diagnosing Polycystic Ovary Syndrome.

   According to this method, a woman must present at least two out of the following three features:

   • Oligo/anovulation: defined as the absence of ovulation and menstruation for prolonged periods, or irregular menstrual cycles lasting more than 35 days or fewer than 8 cycles per year.

   • Biochemical or clinical hyperandrogenism: excess androgens (male hormones) in the blood, such as total or free testosterone and androstenedione, or clinical signs like acne, hirsutism (excess hair growth), and androgenic alopecia.

   • Polycystic ovarian morphology on transvaginal ultrasound, showing 20 or more follicles per ovary (each measuring 2–9 mm in diameter) and/or an ovarian volume greater than 10 ml.

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   If you want to learn more about the causes and symptoms related to Polycystic Ovary Syndrome, you can read our article:

   Polycystic Ovary Syndrome (PCOS): Common Symptoms and How to Recognize Them Early.

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2. Hormonal Markers to Investigate in PCOS

   Another approach to PCOS diagnosis involves measuring certain hormones and related substances in the blood, including: [2]

   • FSH and LH

   • Total and free testosterone

   • DHEAS

   • Prolactin

   • TSH

   • 17-hydroxyprogesterone (to rule out non-classic congenital adrenal hyperplasia)

   • SHBG (sex hormone-binding globulin)

3. Metabolic Parameters in PCOS

   This diagnostic aspect focuses on assessing insulin resistance and cardiovascular risk, which are often present in women with PCOS. The following tests are typically included:

   • Fasting blood glucose

   • Fasting insulin

   • Oral glucose tolerance test (OGTT)

   • Complete lipid profile (HDL, LDL, triglycerides, total cholesterol)

4. Ultrasound for the diagnosis of polycystic ovary syndrome

   The ultrasound used for the diagnosis of PCOS is the transvaginal pelvic ultrasound, as it has a better resolution than the abdominal one, thus giving the gynecologist greater visibility.

   However, as emerges from the interview conducted by Pharmercure "Polycystic ovary syndrome: can it be cured? Learn how to live with it." with Dr. Elisa Maseroli, a specialist in andrology and female endocrinology at Careggi University Hospital in Florence, and Dr. Silvia Federici, an endocrinologist specializing in sexual medicine and hormone therapy at the Auxologico Institute in Milan, both members of the Italian Society of Endocrinology, shows, ultrasound is an additional diagnostic method, but not necessary, especially in young women. In adolescents, the multifollicular appearance of the ovaries can be physiological, making the test unreliable.

5. Conclusions on PCOS Diagnosis

   In conclusion, the Rotterdam Criteria remain the most reliable method for diagnosing Polycystic Ovary Syndrome.

   During the tests, it is also very important to exclude other pathologies that may present some similar or identical symptoms, such as congenital adrenal hyperplasia, Cushing's syndrome, androgen-secreting tumors, thyroid dysfunction, or hyperprolactinemia.

   For this reason, consulting medical professionals specialized in PCOS is crucial.