How to Get an Accurate PCOS Diagnosis: Essential Tests You Need

Your periods are all over the place.
Your skin’s breaking out more. You’ve noticed weight gain, fatigue—or maybe unwanted facial hair. So you Google it… and all signs point to PCOS.

But here’s the thing: not everyone with irregular periods or hormonal acne has PCOS. And not everyone with PCOS presents the same way.

To get the right care, you need the right diagnosis, starting with the right tests.

In this article, we’ll walk you through:

• What PCOS is (and isn’t)
• Why diagnosis is so often misunderstood
• The exact tests you need to confirm it
• What to do if your results are unclear

Let’s cut through the confusion and get to the facts.

What Is PCOS—Really?

Polycystic Ovary Syndrome (PCOS) is a hormonal condition that affects about 1 in 10 women of reproductive age. It’s caused by a complex imbalance of androgens (male hormones), insulin, and ovarian function.

But PCOS is not just about cysts on your ovaries. In fact, you don’t need ovarian cysts to be diagnosed at all.

PCOS affects:

• Your menstrual cycle
• Ovulation
• Skin and hair (due to excess androgens)
• Metabolism and insulin sensitivity

There’s no single test for PCOS—but a proper diagnosis relies on a combination of lab tests, symptoms, and ultrasound findings.

➡️ Read: What Is PCOS? Causes, Symptoms & Treatments

Why PCOS Diagnosis Is Often Missed or Misdiagnosed

Here’s the problem: PCOS looks different for everyone.
Some women have irregular periods. Others ovulate like clockwork but have high testosterone. Others still have cysts on their ovaries—but no other symptoms.

Because of this, PCOS is frequently:

• Misdiagnosed as “just stress” or “normal irregularity”
• Overdiagnosed when people rely solely on ultrasound
• Delayed because it takes an average of 2–3 doctors to get answers

Getting clear starts with understanding the Rotterdam Criteria—the gold standard for PCOS diagnosis.

You need at least 2 out of these 3:

1. Irregular or absent ovulation
2. Clinical or lab signs of high androgens (acne, hair growth, high testosterone)
3. Polycystic ovaries on ultrasound
   

Let’s walk through the tests that help determine each.

 PCOS Diagnosis Testing: What to Ask For

When you see your doctor, request the following evaluations to confirm or rule out PCOS:

1. Hormone Blood Tests

These assess for excess androgens and other hormonal imbalances.

Ask for:

• Total and free testosterone
• DHEA-S (a hormone from your adrenal glands)
• Androstenedione
• LH: FSH ratio (often elevated in PCOS)
• Prolactin (to rule out other causes of irregular cycles)
• TSH (thyroid hormone—issues can mimic PCOS)
  

High testosterone or DHEA-S levels support a PCOS diagnosis—but you can still have PCOS with “normal” ranges.

2. Transvaginal or Pelvic Ultrasound

This looks at ovarian volume and follicle count.

In PCOS, ovaries may appear:

• Enlarged
• With 12+ small follicles per ovary (“string of pearls” look)

Note: You can have PCOS without visible cysts—and you can have cysts without having PCOS.

Ultrasound is most useful when combined with your symptoms and lab results.

3. Menstrual Cycle History

Your provider will ask about:

• Period frequency and duration
• Whether you ovulate regularly
• If your cycle has changed over time

If you’ve had fewer than 9 periods per year or cycles over 35 days, it may point to anovulation—a core PCOS symptom.

Tracking your cycle for 2–3 months can provide helpful data.

4. Metabolic Tests

PCOS isn’t just a reproductive condition—it’s also metabolic.

Request:

• Fasting insulin
• Glucose tolerance test (OGTT)
• Lipid panel (cholesterol and triglycerides)
• Haemoglobin A1c (for long-term blood sugar control)

Even women with a lean body type can have insulin resistance. If left unmanaged, PCOS can raise your long-term risk for type 2 diabetes.

➡️ Explore our diagnostic tools and hormone health support

Expert Insight

“Many women are told they don’t have PCOS just because their ultrasound looks normal. But PCOS is a hormonal condition—not just an imaging one. We need to look at the full clinical picture.”

What to Do If Your Results Are Inconclusive

Sometimes, test results fall into a gray area. Here’s what you can do:

• Ask if your hormones were tested at the right time in your cycle (ideally day 2–5)
• Check if you’re on hormonal birth control, which can mask or skew levels.
• Consider retesting after 3–6 months, especially if symptoms chang.e
• Rule out similar conditions like:
  • Hypothyroidism
    
  • Hyperprolactinemia
    
  • Adrenal disorders
    

Your symptoms matter. Keep advocating if you feel something’s off—even with “normal” results.

➡️ Not sure how to interpret your labs? Book a Care Navigator call

Real-Life Story

“I kept being told my irregular periods were ‘normal.’ No one checked my hormones. After two years of frustration, a reproductive endocrinologist finally ran a full panel—and confirmed PCOS. With the right treatment plan, I’m finally feeling better in my body.”
— Lara, 30

Myth vs Reality

Final Thoughts

Getting a clear, accurate PCOS diagnosis can feel like solving a medical puzzle.
But it’s worth it—because the right diagnosis leads to the right treatment plan, and ultimately, relief.

Testing isn’t about checking boxes. It’s about understanding your body—and giving it the support it needs to thrive.

Call to Action

👉 Think you might have PCOS?
Take our free 5-minute hormone health quiz to determine your symptoms and what to do next.

Sources

• NIH – PCOS Diagnostic Criteria
• Endocrine Society – PCOS Guidelines
• Mayo Clinic – PCOS Diagnosis
• CDC – PCOS Facts

Anna Haotanto

Anna Haotanto is the Founder of Zora Health and a passionate advocate for women’s empowerment. Anna’s personal experiences with egg-freezing, PCOS, perimenopause and the challenges of fertility have fueled her mission to provide high-quality information, financing, and support to help women and couples navigate their fertility journeys with confidence. She is also recognised for her achievements in finance, entrepreneurship, and women’s empowerment, and has been featured in various media outlets. You can also follow her on Linkedin or Instagram.