Is It Really PCOS?
Clinically written and reviewed by Dr. Alessia Milano, ND, a licensed naturopathic doctor registered with the College of Naturopaths of Ontario (Reg. #3697). Last reviewed September 2026.
Polycystic ovarian syndrome, better known as PCOS (PMOS), affects roughly 10–13% of women of reproductive age. Having PCOS myself, I absolutely love treating it. It’s one of the most rewarding conditions I work with. However, there’s a big problem plaguing the PCOS community: PCOS (PMOS) is being both overdiagnosed AND underdiagnosed.
On one hand, the diagnostic criteria we use today (the Rotterdam Criteria) are broader than the ones that came before them, and the number of people who meet criteria roughly doubled when they were introduced. On top of that, an ultrasound finding alone is still often treated as a diagnosis, so many people are labelled with PCOS without a proper workup to confirm it.
On the other hand, people who truly have PCOS wait far too long for answers. In one large international survey, over a third of women waited more than two years for their diagnosis, and nearly half saw three or more health professionals before getting one. That delay matters, because it puts people at greater risk of long-term health consequences.
Clearly, when it comes to PCOS, misdiagnosis is a huge issue. So if you’re dealing with irregular cycles, stubborn acne, hair changes, difficulty losing weight and much more, how do you know if it’s actually PCOS (PMOS)?
Symptoms of PCOS
Before we get into some other possibilities, let’s do a quick review of the most common PCOS symptoms. Classic PCOS symptoms include:
Irregular or absent periods
Difficulty getting pregnant
Excessive hair growth on the body
Thinning and loss of hair on the head
Weight gain - despite your best efforts
Oily skin and acne
Not everyone with PCOS will have a “classic” constellation of symptoms, and this is where the underdiagnosis issue emerges. For example, many women with PCOS are actually quite lean, with no signs other than irregular cycles. In other instances, many women with PCOS have regularly timed cycles, however upon closer inspection have really high testosterone levels on lab work. You get the idea - everyone’s PCOS will look really different, and therefore it’s often missed. As a general rule of thumb, if you’re experiencing any of the above symptoms, see your naturopathic or medical doctor.
how pcos (pmos) is actually diagnosed
PCOS (PMOS) is diagnosed using the Rotterdam Criteria, which were updated in the 2023 international PCOS guideline. You need to meet two of these three criteria:
Irregular or absent periods
High androgens, either clinical signs (excess hair growth, acne, scalp hair thinning) or high levels on blood work
Polycystic ovaries on ultrasound, OR an elevated AMH (anti-Müllerian hormone) in adults
Two important things here. First, an ultrasound alone can NEVER diagnose PCOS. It only ever counts toward one of the three criteria, and a polycystic appearance is common in people who don’t have PCOS at all. If you already meet the first two criteria, you don’t need an ultrasound or AMH to be diagnosed.
Second, and this is the big one, PCOS is a diagnosis of exclusion. That means any and all other conditions that could explain your symptoms must be ruled out first. Unfortunately, this is where many people slip through the cracks, which leads to overdiagnosis.
What Else Could it Be? Looking at other possibilities
On the other hand, because PCOS does look so different in each woman, AND the criteria for diagnosis is so wide, it’s easy to affix the diagnosis of PCOS to women with these symptoms -- even though they might not actually have PCOS at all. Remember, PCOS is a diagnosis of exclusion. That means any and all other possibilities must be ruled out first. Unfortunately, many women slip through the cracks leading to a simultaneous overdiagnosis of PCOS.
So if it’s not PCOS, what else could it be? Here are some other possibilities to consider:
Aftermath of the Pill. When we get off birth control, it takes our body time to relearn how to properly produce and cycle our reproductive hormones. This can lead to PCOS-like symptoms including irregular or absent periods, weight changes, and acne anywhere from 3 months to 1 year after coming off the pill. If you just came off the pill, wait at least 3 months before getting testing done so you get an accurate picture. If symptoms persist well beyond that, it’s worth taking a closer look.
Premature Ovarian Insufficiency. This is when your ovaries lose their function before the age of 40. It causes irregular/absent periods and infertility, making it look a lot like PCOS. Other symptoms to watch out for include night sweats and hot flashes. POI can be ruled out by looking at your pituitary hormone FSH and estradiol on Day 3 of your period. AMH can also be helpful here in unclear cases.
Hypothalamic Amenorrhea. Amenorrhea translates to “no period”. In this condition, there seems to be communication errors between the brain and the ovaries. It can occur due to low weight, chronic stress, and in some cases is unexplained. The big symptom shared with PCOS is- you guessed it - no period. Looking at pituitary hormones such as FSH, LH, prolactin, as well as estrogen, can help diagnose this condition along with a thorough look at your stress, nutrition, and exercise history.
Non-Classical Congenital Adrenal Hyperplasia. Better known as NCAH, this is a genetically inherited disorder that can look a lot like PCOS. Androgen excess symptoms such as acne, increased body hair growth, thinning head hair, irregular cycles, and infertility are often present. This condition can be ruled out by running a simple blood test, 17-OH progesterone, in the morning, early in your cycle.
Cushing’s Syndrome. Cushing’s occurs when your body is producing abnormally high levels of cortisol (your stress hormone). Symptoms can look similar to PCOS and include weight gain, acne, increased hair growth, irregular cycles, and fatigue. Testing includes specialized cortisol testing, such as a 24-hour urine cortisol, late-night salivary cortisol, or a dexamethasone suppression test. A single morning blood cortisol isn’t enough to rule it in or out.
Hypothyroidism. Yes, hypothyroidism can mimic PCOS, and interestingly it frequently occurs together with PCOS. Hypothyroidism can cause irregular or absent periods, weight gain, and metabolic dysfunction also seen in PCOS. Testing includes TSH plus a fuller thyroid panel if needed.
Hyperprolactinemia. Hyperprolactinemia is when your body is producing abnormally high levels of prolactin. Prolactin is your milk stimulating hormone usually only produced while pregnant and breastfeeding. Symptoms that look similar to PCOS include irregular or absent periods, acne, excessive body hair growth, reduced libido, and painful sex. Testing includes prolactin. A mildly high result is often worth repeating, since stress and timing can bump it up.
Androgen-Secreting Tumours. These are rare, but important not to miss. The big clue is how quickly symptoms appear: rapidly increasing hair growth, a deepening voice, or other significant androgen symptoms that come on over months rather than years. Testing: very high testosterone or DHEAS on blood work is a signal to investigate further with your medical doctor right away.
You JUST got your period for the first time. If you’ve only had your period for a couple of years and your cycles are irregular, this does not mean you have PCOS. Irregular cycles are completely normal in the first few years while your body fine-tunes how it produces and cycles hormones. That’s also why ultrasound and AMH aren’t used to diagnose PCOS in teens. If you come out of those first few years and are still experiencing symptoms, then it’s definitely worth taking a closer look.
Other Considerations: Onset & Age
One thing I always ask my patients is WHEN did you start experiencing these symptoms for the first time? Establishing a timeline is so important when it comes to getting a true PCOS diagnosis. Although there are always exceptions to the rule in medicine, I typically find that when PCOS-like symptoms come on abruptly, it’s not PCOS. People with true PCOS often report experiencing symptoms for years, following a slow, steady pattern instead. Symptoms that come on quickly or feel severe are a reason to dig deeper right away.
Next Steps
So you’re experiencing symptoms of PCOS and want to make sure you’re receiving the right diagnosis. What do you do? The biggest piece of advice I can offer is to go visit your primary health care provider and voice your concerns! Ensure you’re getting a thorough workup completed that not only investigates PCOS, but also the many other conditions that look like PCOS listed above. Here are some things I like to look at in my patients with a suspected PCOS (PMOS) diagnosis:
Androgens, including total testosterone, SHBG, and DHEAS, and in some cases androstenedione
Hormones to rule out look-alikes, timed to specific points in your cycle: FSH, LH, estradiol, prolactin, TSH, and 17-OH progesterone
A metabolic assessment, for everyone regardless of weight: hemoglobin A1C, fasting glucose or a 2-hour glucose tolerance test, insulin, a lipid panel, and liver enzymes
Inflammatory markers, like hs-CRP
AMH, for adults, if it’s needed to confirm the diagnosis
Specialized cortisol testing, only when Cushing’s is suspected, or when we want a clearer picture of your stress response
Bottomline: you deserve to be accurately diagnosed. Receiving the wrong diagnosis has real consequences. It delays effective treatment, it decreases your quality of life, and it puts you at risk for long term health concerns. People with PCOS shouldn’t have to deal with this misdiagnosis issue any longer.
If you want to learn more about how Naturopathic Medicine can help support PCOS (PMOS), click here.
Ready to make a change?
When it comes to your health, it’s important to be your own advocate AND have a doctor that will advocate for you. If you’re experiencing PCOS-like symptoms and don’t know where to begin, I’m here for you. For some final words of wisdom, trust your intuition. Nobody knows your body better than you, if something feels off, it usually is. I’m here for you.
With loving compassion,
Dr. Alessia Milano ND
References
Gibson-Helm M, et al. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017. https://www.ncbi.nlm.nih.gov/pubmed/27906550
Teede HJ, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023.