"You probably have PCOS" is one of the most commonly said things in gynaecology clinics across India right now — and yet, for many women, the diagnosis behind it has never actually been confirmed.
PCOS is over-diagnosed because irregular periods alone are often labelled as PCOS without proper investigation. It is under-diagnosed because many women with real PCOS are told their symptoms are just stress or weight gain and sent home without answers.
The truth is, PCOS has specific clinical criteria that doctors look for. It is not a diagnosis you get from one ultrasound or one blood test. And understanding what those criteria actually are can help you ask the right questions at your next appointment.
Here is what a gynaecologist is actually looking for.
What Exactly Is PCOS?
PCOS — Polycystic Ovary Syndrome — is a hormonal condition that affects how the ovaries work. Despite the name, it is not primarily a problem with cysts. It is a metabolic and endocrine disorder that affects your hormones, your menstrual cycle, your metabolism and your fertility.
It is one of the most common hormonal conditions in women of reproductive age, affecting roughly 1 in 5 women in India. Yet it remains widely misunderstood — both by patients and sometimes by the doctors treating them.
How Is PCOS Actually Diagnosed?
PCOS is diagnosed using what is called the Rotterdam Criteria — an internationally accepted framework that requires at least 2 out of 3 of the following to be present:
You need at least 2 of these 3 to confirm PCOS
- Irregular or absent ovulation — meaning your periods are infrequent, unpredictable or missing altogether.
- Signs of high androgens — either clinical signs like excess hair growth and acne, or elevated androgen levels on a blood test.
- Polycystic ovaries on ultrasound — ovaries that contain 12 or more small follicles, or ovaries that are enlarged.
This means you can be diagnosed with PCOS without having cysts on your ovaries. And it means having cysts on an ultrasound alone is not enough to diagnose PCOS. This distinction matters enormously — and it is where a lot of misdiagnosis happens.
What Are the 7 Signs Your Doctor Will Actually Look For?
Are your periods irregular, infrequent or absent?
This is usually the first and most obvious sign. In PCOS, the hormonal imbalance disrupts ovulation — the monthly release of an egg. Without ovulation, the uterine lining does not shed on schedule, which means periods become irregular.
Irregular in PCOS typically means:
- Fewer than 8 periods in a year
- Cycles longer than 35 days
- Periods that are unpredictable and vary significantly in timing from month to month
Having one or two irregular cycles due to stress or illness is not the same as PCOS. The pattern needs to be consistent over time.
Do you have excess hair growth in unexpected places?
Excess facial or body hair — called hirsutism — is one of the clearest clinical signs of high androgens. In PCOS, the ovaries produce more androgens (male hormones like testosterone) than normal. This can cause hair to grow on the face, chin, chest, stomach, inner thighs or upper arms.
Your doctor will assess this using something called the Ferriman-Gallwey score — a clinical tool that maps and scores hair growth across 9 areas of the body. A score above a certain threshold indicates clinically significant hirsutism.
This is a sign many women dismiss or manage cosmetically without realising it could be pointing to a hormonal condition that needs treatment.
Do you have persistent acne, particularly along the jawline?
Hormonal acne driven by high androgens tends to appear along the jawline, chin and lower cheeks. It is often cystic — deeper, more painful and slower to heal than typical teenage acne.
If you have been dealing with adult acne that does not respond well to skincare and keeps coming back in the same areas, it is worth investigating whether androgen excess is the underlying cause.
Are you losing hair from your scalp?
This one surprises many women. The same androgens that cause hair to grow where it should not — on the face and body — can simultaneously cause hair to thin and fall out from the scalp. This is called androgenic alopecia.
It typically presents as thinning at the crown and widening of the parting rather than the receding hairline pattern seen in men. If you are in your 20s or 30s and noticing significant hair thinning, PCOS is worth ruling out.
What does your ultrasound actually show?
A pelvic ultrasound is a standard part of PCOS evaluation — but the results need to be interpreted carefully.
Polycystic ovaries on ultrasound means one or both ovaries contain 12 or more small follicles (each measuring 2 to 9mm) arranged around the edge of the ovary in a string-of-pearls pattern, or that the ovarian volume is greater than 10ml.
Here is the critical point most people miss: up to 20 to 25% of women with completely normal ovarian function can have polycystic-appearing ovaries on ultrasound. This does not mean they have PCOS. The ultrasound finding alone, without the hormonal or menstrual criteria, is not a diagnosis.
What do your blood tests show?
A thorough PCOS workup includes specific blood tests, ideally done on Day 2 or Day 3 of your menstrual cycle. Your doctor should check:
Are you gaining weight, particularly around your middle?
Not all women with PCOS are overweight — lean PCOS is a real and underrecognised pattern. But weight gain, particularly around the abdomen, is very common in PCOS and is closely tied to insulin resistance.
Insulin resistance means your cells do not respond efficiently to insulin, so your body produces more of it. High insulin levels then stimulate the ovaries to produce more androgens, which worsens the hormonal imbalance. This is the central metabolic loop that drives PCOS in many women.
Your doctor may calculate your BMI and waist circumference, and check your fasting blood glucose and insulin levels to assess this.
What Conditions Can Look Like PCOS?
Before confirming a PCOS diagnosis, a good doctor will rule out other conditions that can cause similar symptoms:
Both hypothyroidism and hyperthyroidism can cause irregular periods, weight changes and hair loss.
Elevated prolactin levels can disrupt ovulation and mimic PCOS.
A condition affecting the adrenal glands that can cause high androgen symptoms.
Excess cortisol can cause weight gain, irregular periods and skin changes.
This is why a proper PCOS diagnosis should never be made on one symptom alone or on an ultrasound alone. It requires a clinical assessment, blood tests and imaging together.
Can You Have PCOS If Your Periods Are Regular?
Yes — this surprises many people. A subset of women with PCOS have regular menstrual cycles but still meet the other two Rotterdam criteria: signs of androgen excess and polycystic ovaries on ultrasound. This is sometimes called ovulatory PCOS or non-classic PCOS.
These women often go undiagnosed for years because the irregular period symptom — the most visible one — is absent.
Does PCOS Affect Fertility?
PCOS is the most common cause of anovulatory infertility — infertility caused by irregular or absent ovulation. But having PCOS does not mean you cannot get pregnant. The majority of women with PCOS can conceive, either naturally or with relatively simple interventions like ovulation induction.
If you have PCOS and are trying to conceive, early consultation with a gynaecologist is important so you have a clear picture of where you stand and what options are available to you. Read more about our PCOS & PCOD care to understand how we approach treatment.
What Should You Do If You Think You Have PCOS?
If you recognise several of the signs above, the most important thing is to get a proper evaluation — not a Google diagnosis and not a single ultrasound report.
A thorough assessment should include a clinical history, a physical examination, a targeted set of blood tests and a pelvic ultrasound, all interpreted together by someone with experience in hormonal conditions.
At our practice in Gurugram, we see women with suspected and confirmed PCOS every week. We take the time to do a proper workup, explain what the results actually mean, and create a management plan built around your specific symptoms, your lifestyle and whether or not you are planning a pregnancy.