Diagnosis of Polycystic Ovary Syndrome (PCOS)

Diagnosis of Polycystic Ovary Syndrome (PCOS)

PCOS is one of the most common hormonal imbalances in women today. It is often characterized by insulin resistance (in 70% of cases). The endocrine system is very complex; although PCOS has been recognized and diagnosed for over 75 years, it remains the leading form of endocrine disruption in women of reproductive age. There is still much to learn about how this hormonal imbalance occurs in different women and the most effective ways to treat it.

This syndrome develops for different reasons, and symptoms can also vary from one woman to another, although it is generally accepted that insulin resistance plays an intrinsic role in the syndrome in 70% of cases.

There is no "cure" for polycystic ovary syndrome, even though the question "how to make polycystic ovary syndrome disappear" is one we are regularly asked. However, many women find effective ways to reduce their symptoms without resorting to medication.



"In 2015, after stopping the pill, my cycles were 125 days long. At 25, I suffered from severe cystic and inflammatory acne, my hair was thinning more and more, and mood disorders (anxiety, depression, aggressiveness) were increasingly debilitating in my daily life. I no longer understood my body and felt truly alone in dealing with these issues."

Currently, Imane Harmonie is helping many women manage their various symptoms and raise awareness about PCOS.

Evaluate PCOS Symptoms and Consult a Healthcare Professional

Identifying PCOS begins with recognizing the symptoms. Warning signs include:

  • Irregular or absent menstrual cycles
  • Anovulatory irregular cycles
  • Infertility related to cycle issues
  • Persistent acne
  • Excessive hair growth
  • Significant weight gain associated with major sugar cravings (often linked to high cortisol or insulin resistance)
  • Hair loss (androgenic alopecia) and increasingly thin hair
  • Significant stress accompanied by anxiety or mood swings
  • Severe fatigue

Who Can Diagnose It?

The diagnosis of PCOS is often made by a gynecologist specializing in hormonal disorders or an endocrinologist. However, it can also be made by a midwife or your primary care physician based on various criteria that we will discuss below. These professionals review medical and gynecological history, inquire about symptoms and menstrual cycles, and can prescribe treatments to induce menstruation in women who no longer have periods. They also perform a series of tests to confirm the diagnosis (blood tests, ultrasound, pelvic MRI).

A midwife can also provide expertise in monitoring and managing PCOS, offering holistic support and helping to manage the practical aspects of the condition.

The Rotterdam Criteria: Key to Diagnosis

The Rotterdam criteria, developed by the International Network on Polycystic Ovary Syndrome (PCOS), are a set of clinical guidelines that play an essential role in diagnosing this complex medical condition. These criteria were developed to assist healthcare professionals in consistently identifying and diagnosing PCOS in women exhibiting specific symptoms and characteristics.

The Rotterdam criteria define three main features that can be used to establish a diagnosis of PCOS. According to these criteria, a diagnosis of PCOS is made when at least two of the following three criteria are present:

  1. Irregular menstrual cycles or absence of ovulation when cycles are regular.
  2. Presence of multifollicular ovaries on ultrasound or a high level of anti-Müllerian hormone (AMH) in adults. AMH testing can be optional if there are cycle disorders associated with hyperandrogenism.
  3. Clinical or biological manifestations of hyperandrogenism, such as hirsutism, acne, or high levels of androgens in the blood (elevated testosterone, low SHBG, high DHT or DHEA).

The Rotterdam criteria are essential as they allow for a standardized approach to diagnosing PCOS, crucial given the variability of symptoms and clinical presentations in patients. Each woman suffering from PCOS has different symptoms. By establishing clear and specific criteria, healthcare professionals can diagnose PCOS more consistently, enabling appropriate management and early interventions to help mitigate symptoms and prevent long-term complications.

Furthermore, the use of the Rotterdam criteria also facilitates clinical and epidemiological research on PCOS by enabling comparability between studies conducted in different populations and regions of the world. This contributes to a better understanding of the prevalence, risk factors, and underlying mechanisms of this complex medical condition. In summary, the Rotterdam criteria are a valuable tool for the diagnosis and management of PCOS, thus contributing to the improvement of care and research in this field.

Hormonal Tests and Blood Work: Confirmation Elements

To confirm PCOS, various tests are necessary. The hormonal assessment includes hormone levels measured through a comprehensive blood test. Blood tests are mandatory, unlike ultrasounds, which are not obligatory. The latter simply confirm the results of the blood test.

  • FSH (Follicle Stimulating Hormone): Produced by the pituitary gland, FSH plays a role in the development of ovarian follicles in women.
  • LH (Luteinizing Hormone): Also produced by the pituitary gland, LH is involved in regulating ovulation and the production of sex hormones such as estrogen and progesterone.
  • 17 Beta Estradiol: This is a form of estrogen, a female sex hormone primarily produced by the ovaries, which is important for the development and maintenance of female sexual characteristics and the regulation of the menstrual cycle.
  • Progesterone: Hormone produced by the ovaries after ovulation, essential for maintaining pregnancy and regulating the menstrual cycle.
  • AMH (Anti-Müllerian Hormone): This hormone is produced by the granulosa cells of ovarian follicles and is used as a marker of ovarian reserve, i.e., the quantity of remaining eggs in the ovaries.
  • Prolactin: Hormone produced by the anterior pituitary gland that plays a role in breastfeeding and may also influence ovarian function.
  • Testosterone: Male sex hormone present in small quantities in women, excess of which can contribute to symptoms of hyperandrogenism such as hirsutism and acne. This also includes SHBG, DHEA, and DHT (mentioned below).
  • TSH (Thyroid-Stimulating Hormone) + T3 T4 + ATPO: These tests evaluate thyroid function, as thyroid imbalances can affect the menstrual cycle and contribute to PCOS symptoms.
  • S-DHEA (Dehydroepiandrosterone Sulfate): A precursor of sex hormones, including testosterone, produced by the adrenal glands.
  • Delta-4 Androstenedione: Another precursor of sex hormones, also produced by the adrenal glands.
  • Cortisol: Stress hormone produced by the adrenal glands, which can influence ovarian function and hormone regulation. Sex Hormone-Binding
  • Globulin: A protein that binds to circulating sex hormones and influences their availability in the body.
  • HOMA (Insulin Resistance Test): A test used to assess insulin resistance, a factor often associated with PCOS due to its high prevalence in women with this condition.
  • Vitamin D: Deficient levels of vitamin D have been associated with abnormalities in hormonal metabolism and fertility issues in women with PCOS.

Visual Confirmation (Pelvic Ultrasound & MRI)

Pelvic ultrasound is indeed a step in the diagnostic process of Polycystic Ovary Syndrome (PCOS). This non-invasive procedure allows visualization of the internal structures of the abdomen and pelvis, including the ovaries, using high-frequency sound waves.

During pelvic ultrasound, the physician can observe the ovaries for several characteristics. One of these characteristics is the presence of multiple small follicles in the ovaries. These follicles are fluid-filled sacs containing developing eggs. In women with PCOS, these follicles can accumulate in large numbers, giving the ovaries a "polycystic" appearance.

Visualization of the ovaries and the detection of these multiple follicles are important criteria for diagnosing PCOS. However, it's essential to note that pelvic ultrasound alone doesn't always suffice to confirm the diagnosis of PCOS. Other clinical and biological criteria often need to be considered.

In addition to pelvic ultrasound, MRI (magnetic resonance imaging) can sometimes be used in the diagnostic process of PCOS. MRI provides a more detailed view of the internal structures of the abdomen and pelvis, which can help more precisely assess the size and shape of the ovaries, as well as the presence of abnormal tissues or masses.

MRI can be particularly useful when pelvic ultrasound is inconclusive or when potential complications, such as complex ovarian cysts or tumors, are suspected. It can also be used to evaluate other pelvic and abdominal organs, thus providing a more comprehensive picture of the patient's reproductive health.

In summary, although pelvic ultrasound is often the first step in diagnosing PCOS due to its availability and ease of use, MRI can be a valuable tool to confirm the diagnosis and more precisely assess the ovaries and other internal structures when needed.

Various treatments are available for polycystic ovary syndrome (PCOS), including medical, surgical, and natural approaches.

Medical & Surgical Solutions

Anti-androgens: Medications such as spironolactone or Androcur are used to reduce the effects of male hormones, especially on acne or excessive hair growth.

Metformin: Initially used for type 2 diabetes, metformin may also be prescribed for women with PCOS and insulin resistance to regulate androgen levels and menstrual cycles.

Duphaston: Duphaston contains dydrogesterone, a progestin hormone. It's often prescribed to regulate irregular or absent menstruation in women with hormonal imbalances, including those with PCOS. Side effects include excessive ovarian stimulation leading to nausea, vomiting, abdominal pain, and weight gain.

Clomid: Clomiphene citrate, marketed as Clomid, is often prescribed to stimulate ovulation in women with fertility issues, including those with PCOS. It works by stimulating the ovaries to produce eggs. Side effects include excessive ovarian stimulation, decreased cervical mucus production, onset or exacerbation of endometriosis, breast tenderness, heavier periods, and spotting between periods.

Ovitrelle: Ovitrelle is the trade name for human chorionic gonadotropin (hCG), used to trigger ovulation in women who have undergone ovarian stimulation treatment, such as Clomid or other fertility drugs. Adverse effects include excessive ovarian stimulation leading to nausea, vomiting, abdominal pain, and weight gain.

Surgical Treatments: Ovarian drilling, a procedure involving small punctures of the ovaries, may be considered to reduce the production of male hormones. In vitro fertilization (IVF) may also be recommended for women struggling to conceive naturally.

For more information on the subject, we invite you to read our blog article "How Is Polycystic Ovary Syndrome (PCOS) Treated?"

Natural Solutions

Androgenic Hair Loss:

Saw palmetto: This plant may help reduce androgen levels, thus benefiting from PCOS-related hair loss.

Topical Solutions: Ayurvedic powders such as Brahmi and Amla, mixed with oils like coconut or almond, can nourish the hair and promote growth. Daily scalp massage can also improve circulation and reduce hair loss.

Our supplements for androgenic hair loss:

Irregular Menstrual Cycles:

Shatavari Powder: Used in Ayurvedic medicine to regulate hormonal imbalances and promote regular menstrual cycles.

Chaste Tree (Vitex agnus-castus): Commonly used to balance hormones and regulate menstrual cycles. Check out our Luminaissance supplement.


Supplements like glutamine, zinc, and milk thistle can help reduce inflammation and support liver health, potentially improving acne.

Turmeric, with its anti-inflammatory properties, can benefit acne.

Supporting gut health with probiotics, prebiotics, and fiber-rich foods can also be beneficial. Check out our Venus supplement.


Inositol supplements can help regulate insulin levels and reduce excess male hormones.

Green tea, zinc, kudzu, and saw palmetto can also help balance hormone levels and reduce hirsutism symptoms. Check out our Hirsutism Pack.

Weight Loss:

Supplements like cinnamon, berberine, gymnema sylvestre, and chromium picolinate can help regulate blood sugar and improve insulin sensitivity, facilitating weight management.

Glutamine supplements can reduce sugar cravings and support gut health. Check out our Weight loss Pack.

Excluding Other Pathologies

Several symptoms mentioned earlier may suggest Polycystic Ovary Syndrome (PCOS), but they can also be associated with other conditions. Therefore, it's important to consider multiple diagnoses when evaluating symptoms. Besides PCOS, several other conditions need to be excluded. Among these is Amenorrhea:

Cushing's Syndrome: Cushing's syndrome is a condition characterized by an excess of cortisol in the body, usually caused by excessive cortisol production by the adrenal glands. This can be due to an adrenal tumor, excessive production of ACTH (the hormone that stimulates the adrenals) by the pituitary gland, or prolonged administration of corticosteroids. Symptoms include weight gain, redistribution of body fat (round face, neck, and trunk), thin and fragile skin, purple stretch marks, muscle weakness, and metabolic health issues.

Hyperprolactinemia: Hyperprolactinemia is characterized by high levels of prolactin, a hormone involved in breast milk production in women and the regulation of reproductive function in men and women. It can be caused by pituitary tumors (prolactinomas), certain medications, stress, or other medical conditions. Symptoms in women may include cessation of menstruation, milk production outside of lactation, and infertility. In men, it can cause decreased libido, erectile dysfunction, and milk production (galactorrhea).

Prolactinoma: These are benign tumors of the pituitary gland that produce excess prolactin, leading to the aforementioned hyperprolactinemia.

Congenital Adrenal Hyperplasia (CAH): This is a group of inherited disorders in which the adrenal glands do not produce enough certain hormones, especially cortisol and often aldosterone. This can lead to excessive production of androgens (male hormones) in women, which can result in symptoms such as virilization, excessive hair growth, and genital abnormalities in female newborns.

Hypothyroidism: This is a condition in which the thyroid gland does not produce enough thyroid hormones. This can slow down metabolism and cause symptoms such as fatigue, weight gain, constipation, dry skin, sensitivity to cold, menstrual irregularities in women, and other health issues.

An accurate diagnosis is essential to ensure appropriate treatment and effective management of the condition, whatever it may be.


Understanding the diagnostic process of PCOS is essential for effectively addressing this hormonal condition. With proper symptom evaluation, specialized medical consultation, clear diagnostic criteria, and comprehensive testing, it's possible to make an accurate diagnosis and implement appropriate management. Once diagnosed, seeking medical and emotional support is crucial for navigating the challenges associated with PCOS.