There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms.
Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.
Physical exam. Your doctor will want to measure your blood pressure, BMI, and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.
Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.
Blood tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.
Vaginal ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (lining of the womb). This lining may become thicker if your periods are not regular.
Losing weight helps to reduce the high insulin level that occurs in PCOS. This then improves the chance of you ovulating, which improves any period problems, fertility, and may also help to reduce hair growth and acne. The increased risk of long-term problems such as diabetes, high blood pressure, etc, are also reduced. Losing weight can be difficult. A combination of eating less and exercising more is best. Even a moderate amount of weight loss can help.
The chance of becoming pregnant depends on how often you ovulate. Some women with PCOS ovulate now and then, others not at all. If you do not ovulate but want to become pregnant, then fertility treatments may be recommended by a specialist and have a good chance of success. Commonly used ovulation inducing drugs are clomiphene citrate or aromatase inhibitors. In resistant cases injectable hormone preparations are used to get the desired effect.
Treating period problems
Some women, who have no periods, or infrequent periods, do not want any treatment for fertility. Therefore, some women with PCOS are advised to take the contraceptive pill as it causes regular ‘withdrawal bleeds’ similar to periods.
Metformin and other insulin sensitizing drugs
Metformin is a drug that is commonly used to treat people with type 2 diabetes. It makes the body’s cells more sensitive to insulin. This may result in a decrease in the blood level of insulin which may help to counteract the underlying cause of PCOS. For certain people with PCOS, a specialist may advise that you take metformin or another insulin sensitising drug.
In very rare cases, if ovulation is not achieved with medications, laparoscopic ovarian drilling can be performed to help ovulation induction.