PCOS Symptom Checker
Rotterdam Criteria 2003 · Indian PCOS phenotype · Risk & management guide
Basic details
PCOS typically presents 15–44 years
South Asian overweight cutoff: ≥23
Indian women: abdominal obesity ≥80 cm
Criterion 1 — Menstrual irregularity (oligo / anovulation)
Irregular periods (cycles longer than 35 days or fewer than 9 periods per year)
Criterion 1
Oligomenorrhoea — the most common presenting symptom of PCOS in India. Cycles of 45, 60 or even 90 days are not uncommon in PCOS.
Absent periods for 3 or more consecutive months (amenorrhoea)
Criterion 1
Complete absence of menstruation is the most severe form of anovulation. Must first exclude pregnancy and premature ovarian insufficiency.
Difficulty conceiving / not ovulating (confirmed by BBT chart or OPK)
Criterion 1
Anovulation is often silent — confirmed by persistent negative OPK results, flat BBT chart, or low Day 21 progesterone on blood test.
Criterion 2 — Hyperandrogenism (excess male hormones)
Unwanted hair growth on face, chest, abdomen, inner thighs or back (hirsutism)
Criterion 2
The most visible sign of hyperandrogenism. Coarse, dark terminal hair in a male-pattern distribution. The modified Ferriman-Gallwey score ≥4–6 is significant for Indian women.
Persistent acne not responding to standard skincare (hormonal acne)
Criterion 2
Hormonal acne — typically on the jawline, chin and neck — that persists beyond teenage years or worsens before periods. Often the reason women first visit a dermatologist.
Female pattern hair loss / thinning on scalp (androgenic alopecia)
Criterion 2
Diffuse thinning over the crown and top of the scalp while the frontal hairline is preserved. Caused by androgen sensitivity of scalp hair follicles.
High testosterone or DHEA-S on blood test
Criterion 2
Biochemical hyperandrogenism: free testosterone >2.5 ng/dL or total testosterone >70 ng/dL or elevated DHEA-S. Satisfies Criterion 2 even without visible symptoms.
Criterion 3 — Polycystic ovaries on ultrasound
Polycystic ovaries on ultrasound (≥20 follicles per ovary or ovarian volume >10 mL)
Criterion 3
2018 criteria: ≥20 follicles (2–9 mm) in either ovary or ovarian volume >10 mL on transvaginal ultrasound. Transabdominal USG may miss smaller follicles.
Elevated AMH (Anti-Mullerian Hormone) — typically >5 ng/mL
Criterion 3
AMH is produced by antral follicles. Elevated AMH is a sensitive marker for polycystic ovarian morphology even when ultrasound is suboptimal (e.g. in obese patients).
Associated metabolic & other symptoms
Acanthosis nigricans (dark, velvety skin on neck, underarms, groin)
Metabolic
A visible sign of severe insulin resistance. Extremely common in Indian PCOS patients — often wrongly attributed to poor hygiene. A cardinal sign of metabolic PCOS phenotype.
Unexplained weight gain especially around the abdomen, or difficulty losing weight
Metabolic
Hyperinsulinaemia drives fat storage predominantly in the abdominal region. Many PCOS patients find it extremely difficult to lose weight despite diet and exercise.
Chronic fatigue, low energy or frequent mood changes / depression
Metabolic
Insulin resistance causes cellular energy deficit — cells cannot efficiently use glucose for fuel despite adequate blood sugar. Depression affects 40–50% of women with PCOS.
Difficulty conceiving (infertility) — trying for 6+ months without success
Fertility
PCOS is the most common cause of anovulatory infertility — accounting for 70–80% of cases. However it is also treatable — most women with PCOS can conceive with appropriate management.
Multiple skin tags on neck, armpits or groin
Metabolic
Skin tags (acrochordons) are a clinical marker of insulin resistance. Frequently seen alongside acanthosis nigricans in metabolic PCOS phenotype.
Blood test results (if available)
Elevated LH common in PCOS
LH/FSH ratio >2:1 suggests PCOS
Insulin resistance screening
HOMA-IR can be calculated from this
Rotterdam criteria — real-time status (need 2 of 3 for PCOS diagnosis)
1
Oligo/anovulation — irregular or absent periods, confirmed anovulation
2
Hyperandrogenism — clinical (hirsutism, acne, alopecia) or biochemical (high testosterone)
3
Polycystic ovaries — on ultrasound (≥20 follicles or volume >10 mL) or elevated AMH
0 of 3 criteria met
♀ This tool assesses your symptoms against the Rotterdam Criteria — the international standard for PCOS diagnosis. A score consistent with PCOS does not diagnose PCOS — formal diagnosis requires clinical examination and appropriate investigations by a gynaecologist or endocrinologist.
Please answer at least the menstrual pattern questions to generate your assessment.
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Rotterdam
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Criteria met
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LH / FSH ratio
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HOMA-IR estimate
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Rotterdam criteria — individual status
PCOS phenotype
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Long-term health risks with PCOS
Recommended investigations
Management pathway
Clinical flags
ⓘ For screening purposes only. Not a substitute for clinical examination and physician diagnosis.
PCOS diagnosis requires meeting 2 of 3 Rotterdam Criteria (2003) after exclusion of other causes
of menstrual irregularity and hyperandrogenism (thyroid disease, hyperprolactinaemia, congenital
adrenal hyperplasia, Cushing’s syndrome). Revised 2018 criteria recommend ≥20 follicles per
ovary or ovarian volume >10 mL for ultrasound diagnosis. Refer to a gynaecologist or
endocrinologist for formal evaluation and management.