Describe the diagnostic features of PCOS and its typical workup.

• A. Hyperandrogenism with irregular menses/oligomenorrhea and polycystic-appearing ovaries; workup includes pregnancy test, TSH, prolactin, androgens, fasting glucose/HbA1c, lipid panel; ultrasound if needed.
• B. Hyperandrogenism with regular menses.
• C. Only ultrasound is needed.
• D. PCOS can be diagnosed by estrogen levels alone.

Answer: (C)

The main idea is that PCOS is diagnosed from a pattern of clinical and biochemical features rather than a single test. You look for at least two of these three: irregular or absent ovulation (oligo/anovulation) causing irregular menses, signs or labs of hyperandrogenism (such as hirsutism, acne, or elevated androgen levels), and polycystic-appearing ovaries on ultrasound. Because other conditions can mimic this picture and because ultrasound alone can be inconclusive, you must exclude other causes and confirm the two-of-three pattern rather than rely on ultrasound alone.

The typical workup reflects this approach. Start with a pregnancy test to rule out pregnancy-related causes of amenorrhea and to guide management. Then check thyroid function (TSH) and prolactin to exclude thyroid disorders and hyperprolactinemia as explanations for irregular menses. Measure androgens (total and/or free testosterone, and possibly DHEAS) to assess hyperandrogenism. Screen for metabolic risk with fasting glucose or HbA1c and a lipid panel, given the insulin resistance and cardiovascular risk often associated with PCOS. An ultrasound can document polycystic-appearing ovaries if needed as part of meeting the diagnostic criteria, but it does not establish the diagnosis by itself. Estrogen levels are not part of diagnosing PCOS.