Do I Really Have PCOS? Why a Diagnosis Needs More Than a Teenage Ultrasound
Just last week, I had a 36-year-old woman in my clinic. She’d experienced two pregnancy losses and was holding onto the belief that PCOS was to blame.
When I asked how and when she’d been diagnosed, her answer was something I’ve heard so many times:
“My doctor told me I had cysts on my ovaries when I was a teenager.”
That was it. No follow-up. No comprehensive assessment.
And now, decades later, she was still carrying the weight of that diagnosis, questioning her fertility and her body based on one early scan.
Let’s break this down properly, because not everything that looks like PCOS is PCOS.
What’s not diagnostic?
You might experience:
Acne
Irregular or missing periods
Weight gain
“Cysts” seen on an ultrasound
All of these are common PCOS symptoms, but none of them, alone or even together, are enough to diagnose you.
What is required for a medical diagnosis of PCOS?
To be diagnosed with PCOS, you need 2 out of these 3 criteria:
Irregular or absent ovulation (also called oligo/anovulation)
Signs of high androgens – either visible (like excess hair growth or acne) or found on bloodwork (elevated testosterone or calculated free testosterone)
Polycystic ovaries on ultrasound (10 or more antral follicles on one ovary)
Functional testing can add depth
I often go deeper with clients to assess:
LH:FSH ratio (on cycle day 2–3 if cycling)
AMH (often elevated in PCOS)
SHBG (a low level can suggest high free androgens)
Insulin (resistance is a core driver for many with PCOS)
DHEA-s, cortisol, and prolactin (to rule out adrenal PCOS or stress-based drivers)
Thyroid hormones and inflammatory markers
And increasingly: gut health, as dysbiosis is often part of the PCOS picture
Why this matters
Misdiagnosis can lead to years of the wrong treatment, or no treatment at all.
It can also cause women to internalise a fear-based story about their fertility, when in fact, something entirely different might be going on.
I’ve worked with women who carried the PCOS label for 10, 15, even 20 years, only to find out their symptoms were due to:
Hypothalamic amenorrhoea
Adrenal dysfunction
Thyroid imbalances
And if struggling to conceive, it was due to male fertility factors that were never tested
If you do have PCOS…
Please know: you are not broken.
There are real, effective, evidence-backed ways to address PCOS from the root, including support for insulin resistance, gut health, and nervous system regulation.
But you deserve getting the right assessments and clarity first.
Want to go deeper?
I’d love to support you if you’re unsure what’s behind your symptoms or if you’ve been handed a diagnosis without a full assessment. Appointments can be booked online, or you can email me at info@tessdoig.com if you have any questions.
If you would like to get started on supporting your Metabolic and Hormone Health you can download my FREE bundle which includes:
A 3-day metabolic and hormone support meal plan with recipes
Daily rhythm guide for hormones + nervous system
Metabolic Boost Guide