Now (2026) PMOS – polyendocrine metabolic ovarian syndrome. Takes focus off the ovarian cysts, which are not always seen, often seen incidentally, and probably the least relevant thing about it.
No single test. Also operator dependent esp teens.
- Hirsutism (even male pattern baldness), But NOT virilisation (eg clitoromegaly, voice changes, musculature).
- acne (moderate to severe),
- irregular periods. Can be amenorrhoeic, dysfunctional uterine bleeding, infertility but 20% have normal cycle.
- Obesity (35-50%, not all),
- Acanthosis nigricans.
Insulin resistance is associated, and obviously presents the most important long term risk. Acanthosis nigricans is highly associated with insulin resistance, family history of type 2 or gestational diabetes a clue.
Differential includes pregnancy, hypothyroidism, hyperprolactinaemia (mild hyperprolactinaemia commonly seen in PCOS, transient), late onset Congenital Adrenal Hyperplasia (CAH), ovarian/adrenal tumour, Cushing syndrome.
Investigations
- LH/FSH – ratio often high (3:1 or more) but inconsistent so not considered diagnostic
- Testosterone can be high (up to 4.8) – if higher, suggests alternative diagnosis
- Free androgen index (=testosterone x100/SHBG) can be high but our lab only calculates for adults – reference range of up to 7
- SHBG – low in PCOS (and in obesity, hypothyroidism, hyperprolactinaemia). Plus marker of insulin resistance),
- Prolactin, 17OH Progesterone for differential
- Fasting glucose/insulin ratio (under 4.5=insulin resistance, up to 7 in adolescents), glucose tolerance test, lipids.
No normal range for hormone tests in pubescent girls, so these only give a vague suggestion of an underlying issue.
Given there is no specific treatment, try not to focus on making the diagnosis (with attendant self image issues etc), but concentrate on managing symptoms (for young people, heavy irregular periods and hirsutism; for adults, infertility) and long term risk viz diabetes and cardiovascular disease.
Note that less than 4 menses per year has higher risk of endometrial cancer.
Consider:
- oral contraceptive pill (OCP) – progesterone only, or combined, or else 12 week cycles of medroxyprogesterone acetate 5mg BD followed by 1 week break – NOT contraceptive!
- Metformin
- Spironolactone (has anti androgen effect)
- Plucking/shaving/electrolysis/laser, eflornithine cream
- Clomiphene for fertility.