PCOS Criteria Checklist

This page intentionally does not assign points, a probability, or a low/high band. No validated bedside point score supports those outputs for PCOS.

Medically reviewed by Dr. Taimoor Asghar, physician.

In short: An illustrative PCOS risk score based on the Rotterdam 2003 diagnostic framework: oligo or anovulation, clinical or biochemical hyperandrogenism, polycystic ovarian morphology, with androgen-excess mimics excluded. Learn what the criteria mean and when to see a doctor. Use the calculator above, then read the guide below to interpret your result and its limitations.

Medical review: Dr. Taimoor Asghar, physician and community medicine researcher. Reviewer profile.

What polycystic ovary syndrome is

Polycystic ovary syndrome is one of the most common endocrine conditions in women of reproductive age. The international evidence-based guideline estimates that it affects roughly 6 to 13 percent of women of reproductive age, depending on which diagnostic criteria are applied and how thoroughly women are screened (Teede et al., 2018; Teede et al., 2023). It is characterised by a mix of reproductive and metabolic features: irregular or absent periods because ovulation is infrequent, signs of excess androgens such as coarse body hair growth, persistent acne and thinning hair at the crown, and ovaries that show many small follicles on ultrasound. Many women with PCOS also carry insulin resistance, and weight gain tends to make the whole picture worse.

The condition matters well beyond fertility. The 2023 international guideline, developed by the International PCOS Network under Teede and colleagues, strengthened the recognition of the broader burden: women with PCOS carry higher risks of impaired glucose tolerance and type 2 diabetes, dyslipidaemia, hypertension and cardiovascular disease, obstructive sleep apnoea, and pregnancy complications including gestational diabetes. Depression and anxiety are also substantially more common. This is why a PCOS assessment is never only about periods: a complete workup includes metabolic screening, blood pressure checks, sleep history and mental health screening alongside the hormone evaluation.

Diagnosis is often delayed. Because symptoms such as irregular cycles and acne are common in adolescence and early adulthood, and because the condition sits across gynaecology, endocrinology and general practice, many women wait years before the pieces are put together. A structured, criteria-based approach is exactly what prevents both underdiagnosis and overdiagnosis.

How doctors actually diagnose PCOS: the Rotterdam criteria

In 2003, experts convened by the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) met in Rotterdam to agree on diagnostic criteria. Their consensus, published in 2004, defined PCOS as the presence of at least two of three features in adult women: (1) oligo or anovulation, meaning infrequent or absent ovulation; (2) clinical or biochemical signs of hyperandrogenism, meaning either visible signs such as hirsutism, acne or androgenetic alopecia, or raised androgen levels on blood tests; and (3) polycystic ovarian morphology on ultrasound. Crucially, other disorders that can cause the same symptoms must be excluded first. PCOS is, by definition, a diagnosis of exclusion (Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2004).

The original ultrasound definition used at Rotterdam was the presence of at least 12 follicles measuring 2 to 9 mm in diameter in one ovary, and/or an ovarian volume above 10 ml. Because ultrasound technology has improved dramatically since 2003, the threshold has been revised: the 2023 guideline uses a follicle number per ovary of at least 20 when a modern high-frequency transducer is used, or an ovarian volume of at least 10 ml, with a follicle number per section of at least 10 as the threshold when older technology only allows a transabdominal approach (Teede et al., 2023).

The two-of-three rule creates four recognised phenotypes. A woman can have ovulatory dysfunction plus hyperandrogenism, ovulatory dysfunction plus polycystic ovaries, hyperandrogenism plus polycystic ovaries with regular cycles, or all three. This is why regular periods do not rule out PCOS, and why an ultrasound showing polycystic ovaries on its own does not confirm it. Multicystic ovaries are also seen in healthy adolescents and in women on hormonal contraception, which is why imaging is interpreted strictly within the full clinical context.

What the 2023 international guideline refined

The 2023 update from Teede and colleagues kept the Rotterdam framework but made each criterion sharper and more evidence-based, based on extensive systematic reviews (Teede et al., 2023, Human Reproduction). Several refinements are directly relevant to how this page works.

Ovulatory dysfunction is now defined precisely: a menstrual cycle shorter than 21 days or longer than 35 days, from three years after menarche until perimenopause. In adolescents within three years of menarche, irregularity is common and needs special interpretation; and in adolescents, both ovulatory dysfunction and hyperandrogenism are required for diagnosis, while ultrasound is not recommended because polycystic ovarian morphology is non-specific in the pubertal transition.

A practically important change: in women who already have both irregular cycles and hyperandrogenism, neither ultrasound nor AMH is needed for diagnosis, because two criteria are already met. Ultrasound or AMH is only needed when just one of the two is present. This matters for the calculator below: it never tells you that you need a scan if your answers already cover the clinical criteria.

This honesty is a feature, not a limitation. A tool that invents false precision, saying "you have a 73 percent chance of PCOS", would be misleading. A tool that shows you which Rotterdam boxes your symptoms tick, tells you when the assessment cannot proceed because a mimic needs excluding, and explains exactly what to take to your doctor, is genuinely useful. Use the score as a structured conversation starter with your clinician, not as a verdict.

Why the tool asks about TSH, prolactin and 17-OHP

This is the most clinically important part of the whole page, so it deserves care. PCOS can only be diagnosed after other conditions that cause the same symptoms have been ruled out. Three of the most common mimics are screened with simple blood tests, and all three are required exclusions in both the Rotterdam consensus and the Teede 2023 guideline.

An underactive thyroid (abnormal TSH) can cause irregular periods, weight gain and sometimes raised prolactin, which overlaps heavily with PCOS symptoms. Hyperprolactinaemia (raised prolactin) can cause irregular periods and, if severe, milky nipple discharge; its causes range from stress and medications to a pituitary adenoma, so a raised result always needs proper follow-up. Non-classic congenital adrenal hyperplasia, a milder inherited enzyme defect, can produce hirsutism, acne and irregular cycles that are indistinguishable from PCOS on history alone; it is screened with a morning 17-hydroxyprogesterone (17-OHP) level. Other exclusions include Cushing syndrome and, rarely, androgen-secreting tumours, which is why rapid virilisation is treated as a red flag rather than routine PCOS.

BMI, insulin resistance and long-term health

BMI is not one of the Rotterdam criteria, and this page never treats it as one. But it belongs in any honest PCOS discussion because insulin resistance and obesity aggravate the condition and raise the risk of type 2 diabetes, heart disease and metabolic syndrome (Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2004; Teede et al., 2023). Weight gain worsens symptoms even though the condition occurs at every body size, and weight loss through sustainable lifestyle change improves metabolic risk, though its effect on PCOS features themselves is more uncertain.

One long-term issue deserves a special mention. If periods are absent for months at a time, the uterine lining is exposed to oestrogen without the regular balancing effect of progesterone from ovulation. Over time this raises the risk of endometrial hyperplasia and endometrial cancer. Clinicians protect the lining in this situation, usually with a progestin-containing contraceptive or cyclical progestin, and an absent-periods history should always prompt a discussion about endometrial protection (Teede et al., 2023).

The bands are illustrative labels, so read them as guidance on urgency and next steps rather than as answers:

• Moderate (3 to 5): your answers show some PCOS features. A GP visit is worthwhile to complete the workup, which usually means a hormone panel and, depending on the findings, an ultrasound or AMH test.
• High (6 to 8): your answers map onto several Rotterdam features. Book a clinician appointment for formal assessment; take a record of your cycles over the last year, a note of hair growth pattern and onset, your medication list, and any blood results you already have.

For adolescents, the same bands need extra caution: the 2023 guideline deliberately avoids using ultrasound in this age group because polycystic ovarian morphology is common and non-specific during the pubertal transition, and it requires both ovulatory dysfunction and hyperandrogenism for diagnosis. If you are under 18, or within a few years of your first period, treat the score as a prompt to talk to your doctor rather than as a meaningful number.

When to seek medical care promptly

Some presentations should not wait for a routine appointment. Seek prompt medical assessment if you notice rapid virilisation, such as a deepening voice, increasing muscle bulk or clitoral enlargement, because these can signal an androgen-secreting tumour or severe hyperandrogenism rather than typical PCOS. Milky nipple discharge suggests raised prolactin and needs evaluation. Periods absent for many months deserve assessment for endometrial protection even if you feel well otherwise. Severe or rapidly worsening acne that does not respond to standard treatment, infertility after a year of trying, and significant depression or anxiety all warrant timely care rather than watchful waiting.

Limitations of this tool

Frequently asked questions

References

1. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25. Also published in Hum Reprod. 2004;19(1):41-47.
2. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602-1618.
3. Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2023;38(11):2174-2197.
4. American College of Obstetricians and Gynecologists
5. WHO: Women's Health