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How Is Polycystic Ovary Syndrome (PCOS) Diagnosed?

Clara Siegmund
Clara Siegmund

There isn’t one, single test that gives you a PCOS diagnosis, but certain signs may indicate that you should consider having your doctor do a check-up to see if you meet the PCOS diagnosis criteria.

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Jun 2, 2023
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Sep 27, 2025
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There isn’t one, single test that gives you a PCOS diagnosis, but certain signs may indicate that you should consider having your doctor do a check-up to see if you meet the PCOS diagnosis criteria.

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There isn’t one, single test that gives you a PCOS diagnosis, but certain signs may indicate that you should consider having your doctor do a check-up to see if you meet the PCOS diagnosis criteria.

Polycystic ovary syndrome (PCOS) is a condition that affects hormone levels in people with ovaries. This condition causes hormonal imbalances that can interrupt or alter ovarian function. Between 6% to 12% of reproductive-age people with ovaries have a PCOS diagnosis. But how is PCOS diagnosed?

There isn’t one, single test that diagnoses PCOS, but certain signs may indicate that you should consider having your doctor do a check-up to see if you meet the PCOS diagnosis criteria.

Common signs of PCOS

Signs and symptoms of PCOS can vary from person to person. Some people have a combination of symptoms, while others have just one.

The three main features associated with PCOS are:

  • High levels of hormones generally more present in people assigned male at birth (AMAB), such as androgen or testosterone
  • Irregular menstrual cycles or infrequent to no ovulation
  • Polycystic ovaries, or small fluid-filled sacs (follicles) surrounding the eggs

These features can lead to different signs and symptoms. Here are some of the most common PCOS symptoms:

  • Irregular periods
  • Very heavy periods
  • No periods
  • Menstrual cycles without ovulation (anovulatory cycles)
  • Infertility
  • Weight gain
  • Excess body or facial hair growth (hirsutism)
  • Thinning hair or hair loss on the head
  • Oily skin or acne
  • Patches of thick, darkened skin (acanthosis nigricans)

Some signs of PCOS may not seem like symptoms of a health condition, and telling a doctor about them might not feel necessary. This is one of the reasons that PCOS can go undiagnosed for many people – that is, until they start experiencing irregular cycles, missing periods, or having trouble conceiving.

>>MORE: PCOS Awareness Starts with You: Here's How Oova Can Help

For people dealing with female-factor infertility, PCOS is one of the most common underlying causes. However, PCOS exists outside of the sphere of fertility and conception, as well, and people who aren’t trying to conceive also experience the effects of this condition. For some people, PCOS can start as early as their first period. Others develop the condition in their 20s or 30s.

If you’re experiencing these symptoms, you may want to consider making an appointment with your doctor to get checked out, even if your symptoms don’t seem like a big deal.

PCOS diagnosis

So, you’re experiencing symptoms that could be related to PCOS and you’ve made an appointment with your doctor.

While there isn’t currently one, single test to diagnose PCOS, there are a few things your doctor will likely do to rule out other conditions and arrive at your diagnosis. Here’s how they will proceed.

Medical history review

To begin, your doctor will conduct a thorough review of your medical history. You can expect questions about:

  • Your menstrual cycle
  • The regularity of your periods
  • The symptoms you’ve been having
  • Any history of PCOS in your family, as the condition can run in families

Physical exam

Your doctor will also do a complete physical exam. Among other things, they will look for physical signs that could indicate high levels of certain hormones, like androgen and insulin. These signs include:

  • Excess hair growth, consistent with hirsutism
  • Oily skin or acne
  • Darkened patches of skin

Tests

After these initial steps, your doctor will run some tests. These may include:

  • Blood tests
  • Pelvic exams
  • Ultrasounds

Blood tests check your hormone levels. Pelvic exams are one way to look for growths or abnormalities on your ovaries. Ultrasounds allow your doctor to examine your ovaries more closely and check the thickness of your uterine lining.

PCOS diagnosis criteria

How does a doctor confirm if you have PCOS? After your medical review, exam, and tests, your doctor will determine if you meet the criteria for a PCOS diagnosis. There are three criteria that your healthcare provider looks for:

  • Irregular periods, infrequent periods, or no periods, indications that you’re not regularly ovulating
  • High levels of hormones typically more present in people who are AMAB (such as androgen or testosterone), or physical signs that these hormones are elevated, even if your blood tests come back normal
  • Polycystic ovaries, or small fluid-filled sacs (follicles) surrounding the eggs

If other conditions have been ruled out and you display at least two out of these three criteria, your doctor will diagnose you with PCOS.

>>Oova insight: It’s possible to receive a PCOS diagnosis without doing an ultrasound, since your doctor may be able to determine that you meet the other two diagnosis criteria without needing to check for polycystic ovaries.

What happens after a PCOS diagnosis?

After you receive a PCOS diagnosis, your doctor will work with you to figure out next steps based on your unique situation and what you need and want out of your treatment.

Managing your symptoms

Treating PCOS largely revolves around managing the symptoms that you’re concerned about. You and your doctor can determine which symptoms you want to treat and find the best ways to accomplish that.

  • Regulating your cycle: Your doctor might recommend hormonal birth control or hormone therapy to help regulate your cycle.
  • Acne: Your doctor may prescribe hormonal birth control pills, other medications, or topical creams.
  • Excess hair growth: This may also be treated with hormonal birth control pills. This PCOS symptom may also respond to other types of medication or hair removal options.
  • General symptom management: For some people, changes to diet, exercise habits, or lifestyle may help relieve symptoms, either alone or when combined with medication.
  • Infertility: If you’re trying to conceive, your doctor might prescribe certain medications that can help stimulate ovulation. If you haven’t gotten pregnant after one year of unprotected sex (or six months, if you’re over 35), you may be dealing with infertility. This could be related to your PCOS or to other factors.

Seeing a specialist

It’s possible that your primary care doctor may refer you to a specialist to help determine your specific courses of treatment. Some of the specialists you could see are:

Monitoring your overall health

It’s important to monitor your overall health, as well. PCOS can affect your body in ways unrelated to your reproductive health, and these effects can continue after menopause. PCOS can increase your risk for conditions such as:

  • Type 2 diabetes
  • Heart disease
  • Endometrial cancer
  • High blood pressure
  • Sleep apnea
  • Depression

Depending on your situation, your healthcare provider may recommend regular screening for these complications.

>>MORE: PCOS Treatments: Helping the Whole Person, Not Just Their Symptoms

The takeaway

If you’re noticing symptoms of PCOS, don’t hesitate to bring them up with your doctor, even if they seem unrelated to a health condition. Talking to your healthcare provider about anything and everything that you’re experiencing can help them start to piece together what may be going on in your body. This, in turn, can be the first step towards diagnosing PCOS.

Even though there’s currently no cure for PCOS, the condition can still be manageable. After your diagnosis, you can work with your doctor (or doctors) to help establish your treatment goals and manage the symptoms that you want to address.

About the author

Clara Siegmund
Clara Siegmund is a writer, editor, and translator (French to English) from Brooklyn, New York. She has a BA in English and French Studies from Wesleyan University and an MA in Translation from the Sorbonne. She is passionate about literature, reproductive justice, and using language to make information accessible.‍

Sources

https://www.oova.life/blog/progesterone-supplementation-guide
Can I take progesterone if I'm breastfeeding?
Yes, progesterone is generally safe while breastfeeding and doesn't significantly affect milk supply. However, always discuss with your healthcare provider before starting any hormone supplementation while nursing.
https://www.oova.life/blog/progesterone-supplementation-guide
Is it safe to take progesterone throughout pregnancy?
Yes, when prescribed by your healthcare provider. Progesterone supplementation in early pregnancy is safe and can reduce miscarriage risk in women with low progesterone or a history of pregnancy loss. Most providers continue supplementation through the first trimester (weeks 10-12) when the placenta takes over.
https://www.oova.life/blog/progesterone-supplementation-guide
Can progesterone supplementation cause weight gain?
Progesterone can cause temporary water retention and bloating, which may show up as a few pounds on the scale, but it doesn't cause true fat weight gain. Most women don't experience significant weight changes from progesterone supplementation.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I switch from pills to suppositories or vice versa?
Yes, but only under your doctor's guidance. The dosing and timing may need adjustment when switching between forms since they're absorbed differently. Never switch on your own, especially if you're pregnant or undergoing fertility treatment.
https://www.oova.life/blog/progesterone-supplementation-guide
Will progesterone supplementation delay my period?
Yes, progesterone keeps the uterine lining intact, so if you're not pregnant and continue taking progesterone, your period will be delayed. Once you stop taking it, your period should start within 2-10 days. If you are pregnant, progesterone helps maintain the pregnancy and you won't get a period.
https://www.oova.life/blog/progesterone-supplementation-guide
Should I take progesterone pills orally or vaginally?
For fertility and pregnancy support, vaginal progesterone is usually preferred because it delivers higher concentrations directly to the uterus. For perimenopause or general hormone balance, oral progesterone often works well and is more convenient. Your doctor will recommend the best route based on your specific needs.
https://www.oova.life/blog/progesterone-supplementation-guide
When should I start taking progesterone after ovulation?
Typically, progesterone supplementation for luteal phase support starts 2-3 days after ovulation (confirmed by LH surge or temperature rise). Your doctor will give you specific timing based on your protocol. Some women start immediately after a positive ovulation test.
https://www.oova.life/blog/progesterone-supplementation-guide
What's better: progesterone cream or pills?
Pills (oral micronized progesterone) are generally more effective and reliable than creams because absorption from creams is inconsistent. For medical conditions like fertility issues, low progesterone, or HRT, prescription pills or suppositories are strongly recommended over over-the-counter creams.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
How can I tell if I have low or high progesterone?
The only definitive way to know is through hormone testing via blood tests or at-home urine tests that measure progesterone metabolites. However, symptom patterns can provide clues: anxiety and irregular periods suggest low progesterone, while bloating and extreme fatigue suggest high progesterone.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
When during my cycle should I test progesterone levels?
Test progesterone levels during the luteal phase, typically 7 days after ovulation or around day 21 of a 28-day cycle. This is when progesterone should be at its peak, making it easier to identify if levels are too low or too high.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
What are the main differences between low and high progesterone symptoms?
Low progesterone typically causes irregular or heavy periods, anxiety, hot flashes, and sleep issues. High progesterone causes bloating, fatigue, intense breast tenderness, and depression-like mood changes. Low progesterone symptoms persist throughout your cycle, while high progesterone symptoms are most intense during the luteal phase.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
Can you have symptoms of both low and high progesterone?
Some symptoms like breast tenderness and mood changes can occur with both low and high progesterone, making it confusing. However, the timing, intensity, and accompanying symptoms differ. Hormone testing is the best way to determine which imbalance you're experiencing.
https://www.oova.life/blog/10-dpo
Can stress affect 10 DPO symptoms?
Yes, stress can worsen or mimic 10 DPO symptoms. Stress increases cortisol, which can cause cramping, fatigue, and mood changes similar to both PMS and early pregnancy. During the two-week wait, try stress-reduction techniques like gentle exercise, meditation, or spending time with loved ones.
https://www.oova.life/blog/10-dpo
Is it better to test at 10 DPO or wait?
It's better to wait until 12–14 DPO for more accurate results. Testing at 10 DPO often leads to false negatives because hCG levels may still be too low. If you absolutely can't wait, use a sensitive early detection test with first morning urine, and be prepared to retest in 2–3 days if negative.
https://www.oova.life/blog/10-dpo
What does implantation bleeding look like at 10 DPO?
Implantation bleeding at 10 DPO is typically light pink or brown, much lighter than a period, and lasts 1–2 days. It's often just spotting when you wipe or a few drops on a panty liner. However, only 15–20% of pregnant women experience implantation bleeding—most don't have any bleeding at all.
https://www.oova.life/blog/10-dpo
Why am I cramping at 10 DPO?
Cramping at 10 DPO can be caused by elevated progesterone (whether you're pregnant or not), implantation (if you're pregnant), or premenstrual cramping. Unfortunately, cramping alone can't tell you if you're pregnant since progesterone causes similar symptoms in both scenarios.
https://www.oova.life/blog/10-dpo
What are the chances of a BFP at 10 DPO?
If you're pregnant, you have about a 50–60% chance of getting a positive test at 10 DPO. This means there's a 40–50% chance of a false negative even if you conceived. Chances improve significantly by 12–14 DPO.
https://www.oova.life/blog/10-dpo
What DPO is most accurate for pregnancy testing?
14 DPO (the day of your missed period) is the most accurate time to test, with 99% accuracy. 12 DPO offers 80–90% accuracy. 10 DPO has only 50–60% accuracy. For best results, wait as long as you can—ideally until 12–14 DPO.
https://www.oova.life/blog/10-dpo
Is 10 DPO too early to test?
10 DPO is considered early for pregnancy testing. While some women get positives at 10 DPO, accuracy is only 50–60% if you're pregnant. For best results, wait until 12 DPO (80–90% accuracy) or 14 DPO/missed period (99% accuracy).
https://www.oova.life/blog/10-dpo
Can you have implantation at 10 DPO?
Yes, implantation can still occur at 10 DPO, though 84% of women have already implanted by this point. Late implantation at 10–12 DPO is normal. If implantation happens at 10 DPO, you won't get a positive pregnancy test for another 2–3 days.
https://www.oova.life/blog/10-dpo
What does a negative test at 10 DPO mean?
A negative test at 10 DPO does not mean you're not pregnant. It's very common to get negatives at 10 DPO even if you conceived. Your hCG levels may still be too low, or implantation may have occurred later. Wait until 12–14 DPO to retest for more accurate results.
https://www.oova.life/blog/10-dpo
Can you get a positive pregnancy test at 10 DPO?
Yes, but only about 50–60% of pregnant women will get a positive at 10 DPO. The other 40–50% have hCG levels that are still too low to detect. If you test negative at 10 DPO, wait 2–3 days and test again.
https://www.oova.life/blog/high-progesterone-symptoms
Can high progesterone cause weight gain?
Yes, elevated progesterone can cause temporary weight gain through water retention and bloating. This is a normal part of the luteal phase and early pregnancy.
https://www.oova.life/blog/how-to-increase-estrogen
Does stress affect estrogen levels?
Yes, chronic stress elevates cortisol, which can suppress estrogen production and disrupt hormonal balance. Stress reduction through meditation, yoga, adequate sleep, and self-care practices helps maintain optimal estrogen levels.
https://www.oova.life/blog/how-to-increase-estrogen
When should I consider medical treatment for low estrogen?
Consider medical intervention if natural methods don't improve symptoms after 3 months, if symptoms severely impact quality of life, if you're experiencing early menopause (before 40), or if you have fertility concerns. Hormone replacement therapy may be appropriate in these cases.
https://www.oova.life/blog/how-to-increase-estrogen
What are the signs that my estrogen is increasing?
Signs of rising estrogen include more regular menstrual cycles, reduced hot flashes, improved vaginal lubrication, better mood stability, increased energy, and improved skin elasticity. You may also notice reduced symptoms that originally indicated low estrogen.
https://www.oova.life/blog/how-to-increase-estrogen
Can exercise increase estrogen levels?
Yes, moderate exercise stimulates estrogen release and helps maintain hormonal balance. Aim for 150 minutes of moderate cardio weekly plus strength training twice per week. However, excessive exercise can actually lower estrogen, so balance is key.
https://www.oova.life/blog/how-to-increase-estrogen
How long does it take to increase estrogen naturally?
With consistent dietary and lifestyle changes, you may notice improvements in symptoms within 4-8 weeks. However, significant hormonal changes typically take 2-3 months. Tracking your cycle and symptoms can help you monitor progress.
https://www.oova.life/blog/how-to-increase-estrogen
What foods increase estrogen levels naturally?
Foods high in phytoestrogens can help increase estrogen naturally. The best options include flax seeds (high in lignans), soy products (tofu, tempeh, edamame), lentils, chickpeas, whole grains (oats, quinoa, brown rice), and garlic. These plant compounds mimic estrogen's effects in the body.
https://www.oova.life/blog/perimenopause
What helps relieve hot flashes quickly?
Cool environments, layered clothing, herbal teas, and medical treatments like gabapentin or HRT may help—depending on severity. Lifestyle changes like reducing caffeine and alcohol can also provide relief.
https://www.oova.life/blog/perimenopause
Are there tests to confirm perimenopause?
Yes. Tests measuring estradiol, LH, and FSH levels can indicate hormonal shifts—but diagnosis is often symptom-based since hormone levels fluctuate widely during perimenopause.
https://www.oova.life/blog/perimenopause
How do I know it's perimenopause and not something else?
A doctor may recommend hormone testing (like LH, E3G, and PdG) and track symptom timing. Diagnosis is often based on symptoms combined with age and menstrual pattern changes.
https://www.oova.life/blog/perimenopause
What's the earliest age perimenopause can start?
Some women begin experiencing symptoms as early as their mid-30s, though perimenopause typically starts between ages 38-45.
https://www.oova.life/blog/perimenopause
Does perimenopause affect mental clarity?
Yes. Brain fog and difficulty concentrating are common during hormone fluctuations in perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What happens after the last sign of perimenopause?
After your final period, you enter postmenopause. You'll need 12 consecutive months without a period to confirm menopause. Many symptoms gradually improve, though some like vaginal dryness may persist without treatment.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
When do perimenopause symptoms finally stop?
Some symptoms like brain fog improve after menopause, while others like hot flashes may continue for up to 10 years post-menopause. Vaginal symptoms often persist or worsen without treatment. Each person's timeline is different.
https://www.oova.life/blog/high-progesterone-symptoms
Is high progesterone a sign of pregnancy?
Yes, high progesterone is one of the earliest indicators of pregnancy. Progesterone levels rise significantly after conception to support the developing embryo and reach their peak during the third trimester.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Can you still get pregnant in late perimenopause?
Yes, you can still get pregnant during perimenopause as long as you're having periods, even if they're infrequent. Continue using birth control until you've gone 12 consecutive months without a period and have officially reached menopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Do symptoms get worse before perimenopause ends?
Yes, most perimenopause symptoms intensify in the final 1-2 years before menopause. Hot flashes peak around your final period, vaginal symptoms worsen, and mood changes increase. However, brain fog typically improves in late perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
How long does late perimenopause last?
Late perimenopause typically lasts 1-3 years before your final period. However, the exact duration varies significantly from person to person. You've reached menopause after 12 consecutive months without a period.
https://www.oova.life/blog/high-progesterone-symptoms
What are the symptoms of high progesterone?
High progesterone symptoms include fatigue, bloating, breast tenderness, weight gain, anxiety, depression, headaches, and food cravings. During pregnancy, you may also experience increased nipple sensitivity and muscle aches.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What are the first signs that perimenopause is ending?
The earliest signs include longer gaps between periods (60+ days), intensifying hot flashes that peak around your final period, and worsening vaginal dryness. These symptoms typically increase in late perimenopause before you reach official menopause.
https://www.oova.life/blog/high-progesterone-symptoms
When should I be concerned about high progesterone?
Consult a healthcare provider if you experience high progesterone symptoms outside your luteal phase when not pregnant, or if symptoms include severe pelvic pain, abnormal vaginal bleeding, or rapid weight gain while on hormone therapy.
https://www.oova.life/blog/high-progesterone-symptoms
How do you test progesterone levels?
Progesterone can be measured through blood tests at your doctor's office or at-home urine tests that measure PdG (a progesterone metabolite). Testing is typically done during the luteal phase, about 7 days after ovulation.

About the Oova Blog:
‍Our content is developed with a commitment to high editorial standards and reliability. We prioritize referencing reputable sources and sharing where our insights come from. The Oova Blog is intended for informational purposes only and is never a substitute for professional medical advice. Always consult a healthcare provider before making any health decisions.

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