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Polycystic ovary syndrome

Diagnosing and managing polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine-metabolic disorder in reproductive-aged women.1 It is also a leading cause of female infertility, affecting as many as 5 million women in the United States.2

PCOS is a complex condition that can only be diagnosed by eliminating other disorders with similar symptoms. Quest Diagnostics offers a broad endocrine testing portfolio that can help you accurately diagnose and ascertain the cause of PCOS for appropriate treatment and more effective disease management.

Identifying PCOS can be challenging

Clinical presentations of PCOS encompass a wide spectrum, ranging from mild cases with normal androgens, ovulatory dysfunction, and polycystic ovaries, to severe instances that exhibit marked hirsutism, alopecia, obesity, and high testosterone.1,3,4

Since no single criterion or test can be used to diagnose PCOS, diagnosis is primarily based on the exclusion of diseases with similar symptoms.1,3,4

The 2003 Rotterdam criteria are the most-used approach for diagnosis of PCOS; the Rotterdam consensus defines PCOS based on the presence of at least 2 of 3 criteria:

  • hyperandrogenism
  • ovulatory dysfunction
  • polycystic ovarian morphology (PCOM)1,2,5

The use of 2 of 3 criteria for diagnosis of PCOS results in 4 recognized phenotypes (Table 1).6 Notably, polycystic ovarian morphology (PCOM) on ultrasound is not necessary for diagnosis of PCOS in phenotype B.

Distinguishing similar disorders from PCOS

Once a phenotype has been identified, it is necessary to exclude other disorders to make a diagnosis.1,3,4,7 Many other disorders also satisfy the criteria to diagnose PCOS, such as congenital adrenal hyperplasia (CAH), hyperprolactinemia, obesity, and hypothyroidism.1,3,4 Some of these similar disorders have characteristics that can help distinguish them from PCOS:

Testing for PCOS criteria and differential diagnosis

Individuals suitable for testing:

Identify PCOS earlier with our algorithm

Use our diagnostic algorithm for a step-by-step method to make a PCOS diagnosis based on patient symptoms and test results.

PCOS can put women at risk for comorbidities

Women with PCOS should be assessed and treated for a number of serious comorbidities1,4,5,7,8:


  • Cardiovascular disease (CVD)    
  • Type 2 diabetes
  • Hypertension
  • Metabolic syndrome
  • Abnormal uterine bleeding


  • Endometrial cancer
  • Infertility and pregnancy complications
  • Sleep apnea
  • Nonalcoholic fatty liver disease (NAFLD)

Read our Clinical Focus to learn more about available tests for the differential diagnosis of PCOS and the identification of common comorbidities.

View report


Quest offers a comprehensive range of tests and panels for PCOS criteria and differential diagnosis of disorders with overlapping features, giving you actionable, precise results so you can do more for your patients.
Download PCOS overview


  1. Azziz R. Polycystic ovary syndrome. Obstet Gynecol. 2018;132(2):321-336. doi:10.1097/AOG.0000000000002698
  2. PCOS (polycystic ovary syndrome) and diabetes. CDC. Updated March 24, 2020. Accessed March 29, 2023.
  3. Gibson-Helm M, Teede H, Dunaif A, et al. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017;102(2):604-612. doi:10.1210/jc.2016-2963
  4. Joham AE, Norman RJ, Stener-Victorin E, et al. Polycystic ovary syndrome. Lancet Diabetes Endocrinol. 2022;10(9):668-680. doi:10.1016/S2213-8587(22)00163-2
  5. Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270-284.doi:10.1038/nrendo.2018.24
  6. Teede, H, Misso, M, Costello M, et al. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018. Monash University. Accessed August 14, 2022.
  7. Paschou SA, Polyzos SA, Anagnostis P, et al. Nonalcoholic fatty liver disease in women with polycystic ovary syndrome. Endocrine. 2020;67(1):1-8. doi:10.1007/s12020-019-02085-7
  8. Kumarendran B, Sumilo D, O’Reilly MW, et al. Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome. Eur J Endocrinol. 2019;180(4):256-272. doi: 10.1530/EJE-18-0693

Get the information and testing you need to diagnose and manage PCOS.

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