Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting many Australian women, yet it often goes undiagnosed due to its varied symptoms. If you suspect you might have PCOS, understanding the testing process in Australia can help you prepare and know what to expect. This blog breaks down the typical PCOS diagnostic tests, how they are performed, and what the results mean.
How Is PCOS Diagnosed in Australia?
There is no single test that definitively diagnoses PCOS. Instead, doctors use a combination of clinical evaluation, blood tests, and sometimes imaging to confirm the diagnosis. Australian guidelines, including the 2023 evidence-based PCOS guideline led by Monash University, recommend diagnosis based on a combination of criteria:
- Irregular or absent menstrual periods (indicating ovulatory dysfunction)
- Clinical or biochemical signs of elevated androgens (male hormones), such as excess hair growth or acne
- Polycystic ovarian morphology on ultrasound (presence of many small follicles or enlarged ovaries)
For women over 20, having two of these three criteria typically supports a diagnosis. For younger women, ultrasound is generally not recommended due to natural ovarian changes after puberty.
Step 1: Medical History and Physical Examination
Your doctor will begin by discussing your symptoms, menstrual history, family medical background, and lifestyle. They will also perform a physical exam to look for signs like excess hair growth, acne, or weight changes. This helps identify features suggestive of PCOS and rule out other conditions.
Step 2: Blood Tests
Blood tests are essential to measure hormone levels and exclude other causes of symptoms. Common blood tests in Australia include:
- Testosterone and Free Androgen Index (FAI): To detect elevated male hormone levels.
- Sex Hormone Binding Globulin (SHBG): A protein that binds testosterone, used to calculate free testosterone.
- Other Androgens: Such as dehydroepiandrosterone sulfate (DHEAS) and androstenedione.
- Hormones Regulating Menstrual Cycle: Follicle-stimulating hormone (FSH), luteinising hormone (LH), and estradiol.
- Thyroid Function Tests: To rule out thyroid disorders.
- Prolactin: To exclude hyperprolactinemia.
- 17-Hydroxyprogesterone: To screen for congenital adrenal hyperplasia in some cases.
- Glucose Tolerance Test and Lipid Profile: To assess metabolic risks associated with PCOS.
Important: If you are on the contraceptive pill, you may need to stop it for about three months before testing to get accurate hormone levels. Your doctor will advise on this and alternative contraception during that time.
Step 3: Ultrasound Scan
An ultrasound may be recommended to examine your ovaries and uterus. The preferred method is a transvaginal ultrasound, which provides detailed images of the ovaries to identify the number of small follicles (often called cysts) and measure ovarian size. For women who are not sexually active, a transabdominal ultrasound may be used, though it is less detailed.
Ultrasound findings supporting PCOS include:
- More than 20 small follicles (2-9 mm) in either ovary
- Enlarged ovarian volume (>10 mL)
However, ultrasound is not always necessary for diagnosis, especially if other criteria are clearly met.
What Do the Results Mean?
- Elevated Androgens: Support the diagnosis of PCOS but normal levels do not exclude it.
- Irregular Periods: Indicate ovulatory dysfunction, a key PCOS feature.
- Polycystic Ovaries on Ultrasound: Supportive but not definitive alone, as some women without PCOS have polycystic ovaries.
Your doctor will interpret all results in context and may recommend further tests if other conditions need to be ruled out.
Additional Testing
Depending on your symptoms and risk factors, your healthcare provider may suggest:
- Screening for mental health conditions like anxiety or depression
- Sleep studies if obstructive sleep apnea is suspected
- Ongoing monitoring of blood pressure, blood sugar, and cholesterol
Accessing PCOS Testing in Australia
You can start by consulting your GP, who will coordinate the necessary tests or refer you to specialists such as endocrinologists or gynaecologists. Many pathology labs and imaging centres across Australia provide blood tests and ultrasounds. Some private services also offer comprehensive PCOS hormone panels with detailed reports.
Diagnosing PCOS in Australia involves a thorough assessment combining your medical history, physical signs, blood hormone tests, and sometimes ultrasound imaging. Early diagnosis enables timely management to control symptoms and reduce health risks.