How Is PCOS Diagnosed? What to Expect When Getting Tested

Suspecting polycystic ovary syndrome, now called polyendocrine metabolic ovarian syndrome (PCOS/PMOS), and waiting to find out for sure can feel unsettling. A PCOS/PMOS diagnosis can also bring a welcome sense of clarity, because a diagnosis finally explains symptoms like irregular periods, acne, or unexpected hair growth that may have felt confusing for years.

Many people with PCOS/PMOS go on to build their families with the right support, and our team at The Fertility Institute will be with you from your first test results onward.

What Doctors Look For in a PCOS/PMOS Diagnosis – The Rotterdam Criteria

In 2026, the American Society for Reproductive Medicine (ASRM) endorsed the new PMOS name. The former name focused on ovarian “cysts,” while PMOS reflects that the condition involves hormones and metabolism throughout the body.

The way doctors reach a PCOS/PMOS diagnosis has stayed the same. Under the Rotterdam criteria, adults need any two of the three features below, and doctors will first rule out other conditions with similar symptoms, according to the 2023 international PCOS guideline recommendations published by ASRM.

Irregular or Absent Menstrual Cycles

For adults, irregular cycles mean periods that come less than 21 days apart, more than 35 days apart, or fewer than 8 times a year. Going more than 90 days without a period also counts.

Your doctor will ask about your cycle history early on, since irregular periods can point to irregular ovulation. Ovulation can still be irregular even when periods seem regular, so your doctor may also check progesterone levels to confirm whether you’re ovulating.

Follicle Count on Ultrasound

Polycystic ovarian morphology means an ovary has a higher number of small follicles, the fluid-filled sacs where eggs develop. On a transvaginal ultrasound, the 2023 guideline sets the threshold at 20 or more follicles in at least one ovary.

Ovaries with a higher number of follicles don’t confirm PCOS/PMOS on their own. For adults, an anti-Müllerian hormone (AMH) blood test can be used in place of an ultrasound to assess follicle count.

Signs of Higher Androgen Levels

Androgens are hormones such as testosterone, and higher levels can show up in bloodwork or as physical signs. Your doctor will look at both:

• Bloodwork measuring total and free testosterone.
• Physical signs, including extra hair growth on the face or body (hirsutism), acne, and thinning hair on the scalp.

Hirsutism is the most reliable physical sign, while acne or hair thinning on their own are weaker indicators. Birth control pills can mask androgen levels in bloodwork, so let your doctor know if you’re taking one. If your doctor needs an accurate androgen reading, you may be asked to pause the pill for at least three months and use another form of contraception in the meantime.

What PCOS/PMOS Testing Involves

Your fertility testing visit will bring together your history, bloodwork, and imaging so your doctor can see the full picture. Your visit will include:

• A review of your menstrual history, symptoms, and overall health.
• A review of your family history, since PCOS/PMOS can run in families.
• Bloodwork to check hormone levels, including testosterone and AMH.
• Bloodwork to check your blood sugar, since PCOS/PMOS is closely linked to insulin resistance, which can cause unexpected weight gain or make weight harder to lose.
• Bloodwork to rule out other conditions, such as thyroid stimulating hormone (TSH) for thyroid disorders, prolactin, 17-hydroxyprogesterone, and follicle-stimulating hormone (FSH).
• A pelvic ultrasound, performed by your provider, to look at your ovaries and the lining of your uterus.

Our Fertility Diagnostics Package pairs essential fertility testing with a specialist consultation, giving you a cost-effective way to take the first step.

How Is PCOS/PMOS Diagnosed and How Long Does Testing Take?

Some people will have a clear answer after one visit. When irregular cycles and clear physical signs of higher androgens are both present, your doctor can make a PCOS/PMOS diagnosis once other conditions are ruled out, without an ultrasound or AMH test.

Other people will need a follow-up visit or more testing, especially when only one feature is present. Extra steps are a sign of a thorough team making sure your diagnosis is accurate, so you can move forward with confidence. While you wait on results, our team will keep you updated and answer any questions that come up along the way.

What Happens After a PCOS/PMOS Diagnosis

A diagnosis opens the door to a PCOS/PMOS care plan shaped around your goals. If you’re hoping to conceive soon, our specialists may recommend lifestyle support alongside ovulation induction with medications like letrozole or clomiphene citrate. Medication can also be paired with intrauterine insemination (IUI) or in vitro fertilization (IVF).

If pregnancy isn’t on your mind right now, your plan will focus on managing symptoms and supporting your long-term health, and our specialists can bring in other healthcare professionals when you need extra support. Connecting with others who understand can help too, and PCOS Challenge offers free support groups, including one for people who were recently diagnosed.

Questions to Ask at Your First Appointment

Gathering a few details ahead of time will help your doctor get to know you and make your first visit more productive. Before your appointment, consider writing down:

• Your menstrual cycle history, including how often your periods come and how long they last.
• Any family history of PCOS/PMOS or diabetes.
• Current symptoms, even ones that seem unrelated.
• Medications and supplements you take, including birth control.
• Your goals for building a family, whether that’s soon or someday.

You can also ask your doctor which tests you’ll need, how long results will take, and how a diagnosis would shape your next steps.

Talk to FINO’s Care Team

Getting answers about PCOS/PMOS can turn months of confusing symptoms into a clear plan. Our team at the Fertility Institute will walk through your symptoms, testing, and next steps with you, and we’ll support you every step of the way.

Request an appointment to start the conversation with our care team in New Orleans.