Not everyone with<unk>  has<unk> <unk> es <unk> , nor does everyone with<unk> an cysts have<unk> ; although a pelvic ultrasound is a major diagnostic tool, it is not the only one. The diagnosis is straightforward using the Rotterdam criteria, even when the syndrome is associated with a wide range of symptoms. File:Polycystic_ovary.Transvaginal ultrasound scan of<unk><unk>  File:PCO<unk><unk> .Polycystic<unk>  as seen on sonography Differential diagnosis Other causes of irregular or absent menstruation and hirsutism, such as hypothyroidism, congenital adrenal hyperplasia (21-hydroxylase deficiency), Cushing's syndrome, hyperprolactinemia, androgen secreting neoplasms, and other pituitary or adrenal disorders, should be investigated. Assessment and testing Standard assessment * History-taking, specifically for menstrual pattern, obesity, hirsutism and acne. A clinical prediction rule found that these four questions can diagnose<unk>  with a sensitivity of 77.1% (95% confidence interval CI 62.7%–88.0%) and a specificity of 93.8% (95% CI 82.8%–98.7%). * Gynecologic ultrasonography, specifically looking for small<unk> an follicles. These are believed to be the result of disturbed<unk> an function with failed ovulation, reflected by the infrequent or absent menstruation that is typical of the condition. In a normal menstrual cycle, one egg is released from a dominant follicle – in essence, a cyst that bursts to release the egg. After ovulation, the follicle remnant is transformed into a progesterone-producing corpus luteum, which shrinks and disappears after approximately 12–14 days. In<unk> , there is a so-called "follicular arrest"; i.e., several follicles develop to a size of 5–7 mm, but not further. No single follicle reaches the preovulatory size (16 mm or more). According to the Rotterdam criteria, which are widely used for diagnosis, 12 or more small follicles should be seen in an<unk>  on ultrasound examination. More recent research suggests that there should be at least 25 follicles in an<unk>  to designate it as having<unk> <unk> an morphology <unk> M) in women aged 18–35 years. The follicles may be oriented in the periphery, giving the appearance of a 'string of pearls'. If a high resolution transvaginal ultrasonography machine is not available, an<unk> an volume of at least 10 ml is regarded as an acceptable definition of having<unk> <unk> an morphology instead of follicle count. * Laparoscopic examination may reveal a thickened, smooth, pearl-white outer surface of the<unk> . (This would usually be an incidental finding if laparoscopy were performed for some other reason, as it would not be routine to examine the<unk> es in this way to confirm a diagnosis of<unk> .) * Serum (blood) levels of androgens (hormones associated with male development), including androstenedione and testosterone may be elevated. Dehydroepiandrosterone sulfate levels above 700–800 µg/dL are highly suggestive of adrenal dysfunction because DHEA-S is made exclusively by the adrenal glands. The free testosterone level is thought to be the best measure, with ~60% of<unk>  patients demonstrating supranormal levels. The Free androgen index (FAI) of the ratio of testosterone to sex hormone-binding globulin (SHBG) is high and is meant to be a predictor of free testosterone, but is a poor parameter for this and is no better than testosterone alone as a marker for<unk> ,<unk> sibly because FAI is correlated with the degree of obesity. Some other blood tests are suggestive but not diagnostic. The ratio of LH (Luteinizing hormone) to FSH (Follicle-stimulating hormone), when measured in international units, is elevated in women with<unk> . Common cut-offs to designate abnormally high LH/FSH ratios are 2:1 or 3:1 as tested on Day 3 of the menstrual cycle. The pattern is not very sensitive; a ratio of 2:1 or higher was present in less than 50% of women with<unk>  in one study. There are often low levels of sex hormone-binding globulin, in particular among obese or overweight women. Anti-Müllerian hormone (AMH) is increased in<unk> , and may become part of its diagnostic criteria. Glucose tolerance testing * 2-hour oral glucose tolerance test (GTT) in women with risk factors (obesity, family history, history of gestational diabetes) may indicate impaired glucose tolerance (insulin resistance) in 15–33% of women with<unk> . Frank diabetes can be seen in 65–68% of women with this condition. Insulin resistance can be observed in both normal weight and overweight people, although it is more common in the latter (and in those matching the stricter NIH criteria for diagnosis); 50–80% of people with<unk>  may have insulin resistance at some level. * Fasting insulin level or GTT with insulin levels (also called IGTT). Elevated insulin levels have been helpful to predict response to medication and may indicate women needing higher dosages of metformin or the use of a second medication to significantly lower insulin levels. Elevated blood sugar and insulin values do not predict who responds to an insulin-lowering medication, low-glycemic diet, and exercise. Many women with normal levels may benefit from combination therapy. A hypoglycemic response in which the two-hour insulin level is higher and the blood sugar lower than fasting is consistent with insulin resistance. A mathematical derivation known as the HOMAI, calculated from the fasting values in glucose and insulin concentrations, allows a direct and moderately accurate measure of insulin sensitivity (glucose-level x insulin-level/22.5). * Glucose tolerance testing (GTT) instead of fasting glucose can increase diagnosis of impaired glucose tolerance and frank diabetes among women with<unk>  according to a prospective controlled trial. While fasting glucose levels may remain within normal limits, oral glucose tests revealed that up to 38% of asymptomatic women with<unk>  (versus 8.5% in the general population) actually had impaired glucose tolerance, 7.5% of those with frank diabetes according to ADA guidelines.
Polycystic ovary syndrome
Hypothyroidism
Gonadotropin-resistant ovary syndrome
Hyperprolactinaemia
Functional hypothalamic amenorrhea
Congenital adrenal hyperplasia
Lactational amenorrhea
Metabolic syndrome