Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal conditions, affecting about 1 in 10 women and people with ovaries worldwide. Yet, despite how common it is, many people go undiagnosed for years. Some spend their teens and twenties struggling with irregular cycles, acne, weight changes, or fertility issues only to find out much later that PCOS was the underlying cause all along.

So why does PCOS diagnosis take so long?

Unlike conditions with a single clear test, PCOS is a diagnosis of exclusion. That means doctors have to piece things together while ruling out other possible causes. Leading to many people bouncing between doctors before getting answers.

Here are some reasons why:

1. Symptoms overlap – Irregular cycles, acne, or weight changes are often blamed on stress, puberty, or lifestyle.
2. Inconsistent knowledge – Not all healthcare providers are well-trained in women’s hormonal health.
3. Invisible symptoms – Things like insulin resistance or mood changes aren’t obvious, so they get overlooked.
4. Cultural stigma – In many places, conversations around periods, infertility, or “women’s problems” are avoided, delaying medical help.
   

The Main Diagnostic Criteria

The most widely used framework is the Rotterdam Criteria (2003). To be diagnosed with PCOS, a person needs to meet at least 2 out of 3:

1. Irregular or absent ovulation – seen as irregular, infrequent, or absent periods.
   
2. Signs of high androgen levels – either clinically (visible signs like acne, excess hair growth, thinning hair) or through blood tests showing elevated testosterone/androgens.
   
3. Polycystic ovaries on ultrasound – ovaries showing many small follicles.

Important note: The term “cysts” is misleading. In PCOS, these aren’t abnormal growths but rather immature follicles; tiny fluid-filled sacs, each holding an egg. In a typical cycle, one follicle matures and releases an egg. In PCOS, many start developing but don’t mature enough to release one, staying in the ovary and creating a “string of pearls” appearance on ultrasound.

However:

• Not everyone with PCOS has this ultrasound pattern.
• And not everyone with polycystic ovaries has PCOS.

This is why ultrasound alone is never enough for diagnosis.

Other conditions like thyroid disorders, high prolactin, or adrenal issues must also be ruled out before confirming PCOS.

In addition to the pelvic ultrasound, some other common tests in PCOS Diagnosis include;

• Blood tests: to check hormone levels (androgens, LH, FSH, prolactin, thyroid, insulin, glucose).
• Medical history & physical exam: Menstrual cycle tracking, weight patterns, acne, hair growth.
  

Bottom line: Getting a PCOS diagnosis can feel like a long, confusing journey but knowledge is power. Understanding how PCOS is diagnosed and exploring the different ways it may present can help you advocate for yourself and find the right treatment plan.

PCOS is complex, and no two cases look exactly alike. You can’t self-diagnose PCOS. If you suspect it, ask your doctor for hormone tests and a full evaluation.