PCOS Diagnosis and Management

Diagnostic Evaluation

The Endocrine Society recommends that women with PCOS undergo a clinical assessment to identify signs of hyperandrogenism, such as hirsutism, acne, and male-pattern hair loss, as well as obesity or increased waist-hip ratio (>0.9) suggesting truncal obesity 2, 3
Hormonal evaluation should include free testosterone levels, LH/FSH ratio, and fasting glucose/insulin ratio to assess insulin resistance, with a ratio >2 suggesting PCOS 2, 3
Transvaginal ultrasound is preferred for evaluating ovarian morphology, with diagnostic criteria for polycystic ovaries including ≥20 follicles (2-9mm) in at least one ovary or ovarian volume ≥10ml in at least one ovary 1, 4

Women with PCOS, even those with regular cycles, should be monitored for metabolic abnormalities, including insulin resistance and dyslipidemia, as well as increased cardiovascular risk, according to the American College of Obstetricians and Gynecologists 5
The American Heart Association recommends that women with PCOS be screened for cardiovascular risk factors, including hypertension, hyperlipidemia, and diabetes 5
Women with PCOS should also be evaluated for potential endometrial hyperplasia, even with apparently regular cycles, as recommended by the American College of Obstetricians and Gynecologists 5