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Diagnosis and investigation of PCOS (Polycystic ovarian syndrome)


At least 2 of following present:

  1. Infrequent or absent ovulation
  2. Clinical or biochemical evidence of hyperandrogenism
  3. Polycystic ovaries on ultrasound examination

Exclude other causes of hyperandrogenism: ovarian/adrenal tumours, congenital adrenal hyperplasia, Cushing’s syndrome.

Suspect PCOS if presentation with:

especially if accompanied by obesity, acanthosis nigricans or FH of PCOS.


To establish the diagnosis:

Pelvic ultrasound (transvaginal) – classic picture of PCOS:

LH, total testosterone, free androgen index not mandatory for diagnosis.

To exclude other causes of oligo- and amenorrhoea:

To exclude other causes of hyperandrogenism if suspected:

Total testosterone, free androgen index (normal to moderately raised in PCOS but very high with tumours), DHEAS (very high with adrenal tumours). Ultrasound/MRI examination of ovaries and adrenals where indicated.

If overweight or frankly obese:

Anil Gudi , Amit Shah and Prof Homburg

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