Why Doctors Struggle to Diagnose PCOS (Episode 484)

Full Transcript: Episode 484

Lisa:

Today I’m sharing a brand new episode in my FAM Research Series. We’ll be looking at a specific study that explores why so many women struggle to get an accurate diagnosis from their practitioners—focusing on a survey of physicians and their knowledge of PCOS diagnostic criteria.

The study is titled: “Gaps in Knowledge Among Physicians Regarding Diagnostic Criteria and Management of Polycystic Ovary Syndrome.” It surveyed 630 physicians—OBGYNs and reproductive endocrinologists—from professional societies including ACOG and the American Society of Reproductive Medicine.

The results were striking. Only 68% of reproductive endocrinologists and 41% of OBGYNs applied the widely accepted Rotterdam criteria for diagnosing PCOS. That means over 30% of reproductive endocrinologists and 60% of OBGYNs surveyed either used different criteria or weren’t sure which to use.

If you’re not familiar with the Rotterdam criteria, here’s a quick breakdown. It includes three primary features:

1. Oligomenorrhea or anovulation – often seen as long or irregular cycles.
2. Hyperandrogenism – either clinical symptoms (like hirsutism or cystic acne) or elevated androgens on lab tests.
3. Polycystic ovaries visible via ultrasound – often described as a “string of pearls” pattern or increased ovarian volume.

To meet the Rotterdam criteria, two out of the three features must be present. It’s not sufficient to meet just one. For instance, having cysts on the ovaries alone isn’t enough, nor is irregular cycling without androgen excess or cysts.

Another set of criteria—the Androgen Excess and PCOS Society definition—requires androgen excess plus one of the other two markers. But the Rotterdam criteria remains the most widely accepted among clinicians globally.

So how does this impact patient care?

I’ve worked with many women over the years who clearly meet these diagnostic criteria—based on their cycle charts and clinical symptoms—yet they weren’t screened for PCOS. Often, that’s because their appearance didn’t match the practitioner’s expectation of what PCOS “looks like.” Weight bias is a major issue. Some practitioners mistakenly consider body weight as a diagnostic factor, even though it isn’t part of the established criteria.

I’ve also seen the reverse: women diagnosed with PCOS based solely on cysts or cycle irregularities, even though they didn’t meet the full criteria. These misdiagnoses often occur when the practitioner is unfamiliar with the correct diagnostic guidelines.

This contributes to the widespread delay in diagnosis. Studies show that women with PCOS often wait two years or more—and consult multiple practitioners—before receiving a diagnosis. That’s despite PCOS being one of the most common reproductive endocrine disorders, affecting roughly 15% of women and representing the most common cause of anovulatory infertility.

Other findings from the study showed that many physicians over-associate ovarian cysts with PCOS. While cysts are a feature of the condition, they’re also found in a significant portion of the general population and are not diagnostic on their own. 68% of OBGYNs and 35% of reproductive endocrinologists surveyed associated cysts with PCOS without considering the full criteria.

Physician awareness of other symptoms was mixed. While most recognized the link with weight and exercise, fewer were aware of mental health impacts like anxiety, depression, and reduced quality of life. Unsurprisingly, hormonal birth control was the most commonly recommended management strategy—especially for those not trying to conceive—but fewer than half of the physicians discussed counseling or other management options with patients.

So, what does all this tell us?

Even among highly specialized physicians, awareness of PCOS diagnostic criteria and management options is lacking. And if that’s the case with specialists, it raises serious concerns about the level of knowledge among general practitioners.

This study validates what many of you may have experienced—whether as patients or as practitioners supporting women. It explains why symptoms may be dismissed or misdiagnosed, and why conditions like PCOS can go undetected or be wrongly labeled.

Ultimately, this highlights the importance of using the menstrual cycle as a diagnostic tool—and of empowering both clients and practitioners with evidence-based tools and education. As this study shows, even the most common conditions can be overlooked when diagnostic knowledge is lacking.

Thanks for listening to this episode. If it resonated with you or someone you know, please share it. For the full list of episodes in the FAM Research Series, head over to fertilityfriday.com/research. And if you’re a women’s health professional looking to use fertility awareness in your practice, visit fertilityfriday.com/FAMMLIVE.