There’s no test to definitively diagnose PCOS. Your doctor is likely to start with a discussion of your medical history, including your menstrual periods and weight changes. A physical exam will include checking for signs of excess hair growth, insulin resistance and acne.
Your doctor might then recommend:
- A pelvic exam. The doctor visually and manually inspects your reproductive organs for masses, growths or other abnormalities.
- Blood tests. Your blood may be analyzed to measure hormone levels. This testing can exclude possible causes of menstrual abnormalities or androgen excess that mimics PCOS. You might have additional blood testing to measure glucose tolerance and fasting cholesterol and triglyceride levels.
- An ultrasound. Your doctor checks the appearance of your ovaries and the thickness of the lining of your uterus. A wandlike device (transducer) is placed in your vagina (transvaginal ultrasound). The transducer emits sound waves that are translated into images on a computer screen.
If you have a diagnosis of PCOS, your doctor might recommend additional tests for complications. Those tests can include:
- Periodic checks of blood pressure, glucose tolerance, and cholesterol and triglyceride levels
- Screening for depression and anxiety
- Screening for obstructive sleep apnea
PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication.
Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — for example, losing 5 percent of your body weight — might improve your condition. Losing weight may also increase the effectiveness of medications your doctor recommends for PCOS, and can help with infertility.
To regulate your menstrual cycle, your doctor might recommend:
- Combination birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.
- Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn’t improve androgen levels and won’t prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.
To help you ovulate, your doctor might recommend:
- Clomiphene (Clomid). This oral anti-estrogen medication is taken during the first part of your menstrual cycle.
- Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.
- Metformin (Glucophage, Fortamet, others). This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don’t become pregnant using clomiphene, your doctor might recommend adding metformin. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.
- Gonadotropins. These hormone medications are given by injection.
To reduce excessive hair growth, your doctor might recommend:
- Birth control pills. These pills decrease androgen production that can cause excessive hair growth.
- Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin. Spironolactone can cause birth defect, so effective contraception is required while taking this medication. It isn’t recommended if you’re pregnant or planning to become pregnant.
- Eflornithine (Vaniqa). This cream can slow facial hair growth in women.
- Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.