Polycystic ovary syndrome, now known as polyendocrine metabolic ovarian syndrome (PCOS/PMOS), can show up in so many different ways that suspecting PCOS/PMOS, and waiting to know for sure, can feel unsettling. A diagnosis can also bring a welcome sense of relief, because unpredictable periods, stubborn acne, or unwanted hair growth will finally have an explanation you can act on.
At MCRM Fertility, you’re an individual with your own story, and our team will help you understand every part of the diagnostic process so you can move forward with clarity.
What Doctors Look For in a PCOS/PMOS Diagnosis – The Rotterdam Criteria
PMOS stands for polyendocrine metabolic ovarian syndrome, the new name the American Society for Reproductive Medicine (ASRM) endorsed in 2026. “Polyendocrine” and “metabolic” reflect that the condition involves several hormone systems and metabolism, while the older name centered on ovarian “cysts.”
The name has changed, and the way doctors reach a PCOS/PMOS diagnosis has stayed the same. Using the Rotterdam criteria, adults need two of the three signs below, after other possible causes are ruled out, according to the 2023 international PCOS guideline recommendations published by ASRM.
Irregular or Absent Menstrual Cycles
Your doctor will ask about your periods early on, because PCOS/PMOS can make ovulation irregular or stop ovulation altogether. For adults, the guideline defines irregular cycles as shorter than 21 days, longer than 35 days, fewer than 8 cycles a year, or any one cycle lasting longer than 90 days.
Ovulation can be irregular even when periods seem to arrive on schedule. If your doctor needs to confirm ovulation, a progesterone blood test can help.
Follicle Count on Ultrasound
Follicles are the small, fluid-filled sacs that contain developing eggs. During a transvaginal ultrasound, your provider will perform an antral follicle count, and 20 or more follicles in at least one ovary meets the adult threshold.
Seeing many follicles on ultrasound isn’t a PCOS/PMOS diagnosis by itself, since some people have a higher follicle count without the condition. Adults can also have an anti-Müllerian hormone (AMH) blood test in place of the ultrasound to assess follicle count.
Signs of Higher Androgen Levels
Androgens, such as testosterone, can be higher with PCOS/PMOS, and your doctor will weigh two kinds of evidence:
- Lab results from total and free testosterone bloodwork.
- Physical signs, including excess hair on the face, chest, or back (hirsutism), acne, or thinning hair on the scalp.
Excess hair growth is the most telling physical sign, while acne or hair thinning alone are less conclusive. Birth control pills can lower androgen levels in bloodwork, so your doctor may recommend pausing the pill for at least three months when accurate results are needed.
What PCOS/PMOS Testing Involves
PCOS/PMOS testing at MCRM fits naturally into our fertility screening process. Your testing will include:
- A thorough health history and physical exam, including your menstrual cycles and symptoms.
- Questions about relatives with PCOS/PMOS, since the condition can run in families.
- Ovarian function testing to see whether you’re ovulating regularly.
- Hormone bloodwork, including testosterone and AMH.
- Bloodwork to check your blood sugar for signs of insulin resistance, which is common with PCOS/PMOS and can make weight harder to lose or lead to unexpected weight gain.
- Bloodwork to rule out other conditions, such as thyroid stimulating hormone (TSH) for thyroid disorders, prolactin, 17-hydroxyprogesterone, and follicle-stimulating hormone (FSH).
- A transvaginal ultrasound, performed by your provider, to look at your ovaries and uterus.
Before your initial appointment, you’ll complete your health history forms through our patient portal, which gives your doctor time to review your history ahead of your visit. Our team can also help you check your insurance coverage for testing.
How Is PCOS/PMOS Diagnosed and How Long Does Testing Take?
For some people, a diagnosis can come quickly. If you have irregular cycles and clear physical signs of higher androgens, your doctor can confirm PCOS/PMOS once other conditions are ruled out, with no ultrasound or AMH test required.
For others, the picture takes a little more time. Your doctor may add an ultrasound, AMH testing, or a follow-up visit when only one sign is clear, and those extra steps help make sure your diagnosis is accurate and your plan fits you. Our team will keep you updated as results come in, so you’ll never be left guessing about what comes next.
What Happens After a PCOS/PMOS Diagnosis
A PCOS/PMOS diagnosis gives you and your care team a clear starting point. If you’re hoping to conceive soon, your plan may include ovulation induction to help you ovulate on a more predictable schedule, intrauterine insemination (IUI), or in vitro fertilization (IVF), depending on your test results and goals. Your doctor will explain how each option fits your results, and you’ll decide on next steps together.
If pregnancy isn’t part of your plans yet, your care will focus on managing symptoms and supporting your long-term health, and nutrition and fitness strategies can play a helpful role. Many people with PCOS/PMOS go on to build their families, and you can learn more about PCOS/PMOS and fertility or hear from Dr. Mira Aubuchon about PCOS/PMOS whenever you’re ready.
Questions to Ask at Your First Appointment
Coming prepared can help you get the most from your first visit. Before your appointment, jot down:
- Your menstrual history, including how often your periods come, how long they last, and any recent changes in your weight.
- Any family history of PCOS/PMOS or diabetes.
- The symptoms you’ve noticed, even ones that seem unrelated.
- All medications and supplements you take, including birth control.
- Your goals for building your family, whether that’s soon or further down the road.
You can also ask your doctor which tests you’ll need, when your results will be ready, and how a PCOS/PMOS diagnosis could shape your options.
Talk to MCRM’s Care Team
Whatever your symptoms have been telling you, you deserve answers and a team that will walk beside you as you find them. Our caregivers in St. Louis and Tulsa will listen to your story, guide you through testing, and support you through every step that follows.
Request an appointment to talk through your symptoms and next steps with our care team.