Polycystic Ovarian Syndrome or PCOS is a common endocrine disorder among women of reproductive age affecting around 6-10% of women worldwide. It is characterized by irregular or prolonged menstrual bleeding, excess androgen levels and cysts on the ovaries. With varied symptoms like menstrual irregularities, infertility issues, excessive facial and body hair growth, acne, obesity and metabolic complications, it can be difficult to diagnose PCOS. In this article, we will look at the diagnostic process followed by doctors to determine if a patient has PCOS.

Clinical Evaluation

The first step is a detailed clinical evaluation where the doctor records a patient's medical history and conducts a physical examination. They check for signs of hyperandrogenism like excessive hair growth and acne. They also record details of menstrual history looking for irregularities, bleeding between periods or prolonged bleeding. During physical examination, they check for abdominal tenderness, look for signs of obesity and check blood pressure levels. This evaluation helps the doctor identify possible signs and symptoms of PCOS.

Laboratory Tests

If clinical evaluation suggests PCOS, the doctor then orders certain laboratory tests. One of the key tests done is measuring Ferriman-Gallwey (FG) score which checks for excess hair growth in different body parts in females. High FG score above 6 indicates hyperandrogenism. Blood tests to check hormone levels like Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), testosterone and prolactin are also done. High levels of LH relative to FSH is seen in most PCOS cases. Excess levels of testosterone and DHEA-sulfate further confirm hyperandrogenism. Thyroid screening tests are also performed to rule out thyroid issues.

Ultrasound Evaluation

Transvaginal ultrasound of the ovaries and pelvis is an important diagnostic tool for PCOS. It checks for features like enlarged ovaries (more than 10cc in volume) with multiple cysts visible as follicles measuring 2-9 mm in diameter. Cysts form due to excessive stimulation of ovaries by LH. Presence of 12 or more follicles in each ovary or an ovarian volume more than 10cc strongly indicates PCOS. Ultrasound also helps rule out other disorders like ovarian tumors.

Rotterdam Criteria for Diagnosis

Based on the clinical evaluation, laboratory reports and ultrasound findings, doctors use Rotterdam criteria to make a conclusive diagnosis of PCOS. As per these criteria, for a definite diagnosis of PCOS, a patient must have at least two of the following three features:

1. Irregular periods or amenorrhea

2. Clinical and/or biochemical signs of hyperandrogenism

3. Polycycstic ovaries seen on ultrasound with multiple small follicles.

Meeting any two of these criteria confirms a diagnosis of PCOS. Presence of all three features strongly indicates PCOS. Ruling out other disorders mimicking PCOS symptoms through appropriate tests helps achieve an accurate diagnosis.

Differential Diagnosis

Since PCOS shares symptoms with other disorders, the doctor also rules out conditions like Cushing's syndrome, congenital adrenal hyperplasia, thyroid disorders, hyperprolactinemia and androgen-secreting tumors. Appropriate tests are done to check for severity of symptoms and differentiation. For example, high early-morning cortisol levels indicate Cushing's syndrome. Abnormal 17-hydroxyprogesterone levels point to congenital adrenal hyperplasia. Ruling out such conditions is important for correct diagnosis of PCOS.

Conclusion

Diagnosing PCOS requires a thorough clinical workup including medical history, physical examination, laboratory tests and imaging studies. Doctors follow standardized Rotterdam criteria to make a definite diagnosis after ruling out other related disorders. An accurate diagnosis helps develop an effective treatment plan focusing on lifestyle changes and medications to manage symptoms and reduce complications. Ongoing research into exploring new diagnostic biomarkers may further streamline the process in future.