Polycystic Ovary Syndrome (PCOS) is a common hormonal condition that affects many Australian women, but getting a timely and accurate diagnosis can sometimes be challenging. Understanding the current guidelines and what to expect during the diagnostic process can help women advocate for their health and access the care they need.
How Is PCOS Diagnosed in Australia?
PCOS is diagnosed using a combination of your medical history, physical symptoms, blood tests, and sometimes ultrasound imaging. Australian doctors follow the internationally recognised “Rotterdam criteria,” which require at least two out of three key features to be present, after ruling out other possible causes:
- Irregular or absent periods (oligo/anovulation): This usually means menstrual cycles that are longer than 35 days, shorter than 21 days, or periods that are unpredictable or missing altogether.
- Signs of excess androgens (hyperandrogenism): This can be clinical (such as excess hair growth, acne, or scalp hair thinning) or biochemical (higher than normal levels of male hormones like testosterone in blood tests).
- Polycystic ovaries on ultrasound: Defined as 12 or more follicles visible on one ovary, or an ovary that is larger than normal. Some guidelines now use a higher threshold of 20 or more follicles per ovary, or increased ovarian volume, as ultrasound technology improves.
You only need two of these three features for a diagnosis, and other conditions that could explain your symptoms must be excluded first.
The Evolving Role of Ultrasound
Recent Australian-led guidelines highlight that ultrasound is not always necessary for diagnosis, especially in adult women who already have both irregular cycles and signs of excess androgens3. For adolescents (within 8 years of starting periods), ultrasound is generally not recommended because normal ovarian development can look similar to PCOS on scans. In these cases, diagnosis relies more on symptoms and hormone levels, and young women with some features should be monitored over time.
The Diagnostic Process
Here’s what you can expect if you’re being assessed for PCOS in Australia:
- Medical History: Your doctor will ask about your menstrual cycle, symptoms like acne or hair growth, weight changes, and family history.
- Physical Examination: Looking for signs of excess androgens, such as facial or body hair and acne.
- Blood Tests: To check hormone levels (including testosterone and other androgens), and to rule out other causes such as thyroid or adrenal issues.
- Ultrasound (if required): An internal (transvaginal) or external (transabdominal) scan may be used to check for polycystic ovaries, but this is not always needed, especially for younger women or when other criteria are clearly met.
Why Timely Diagnosis Matters
Many women in Australia experience delays in diagnosis, sometimes seeing multiple doctors before getting answers. Early diagnosis is important because PCOS is linked to long-term health risks like type 2 diabetes, heart disease, and fertility challenges. The latest guidelines aim to standardise care, reduce unnecessary testing, and ensure women receive clear information and support at every stage.
PCOS diagnosis in Australia follows clear, evidence-based criteria that focus on symptoms, hormone levels, and sometimes ultrasound findings. If you have irregular periods, signs of excess androgens, or concerns about your reproductive health, speak to your GP or a women’s health specialist. Early assessment and diagnosis can help you manage symptoms and reduce future health risks.