Surreal illustration symbolizing PCOS overdiagnosis

PCOS Overdiagnosis: Are We Unnecessarily Labeling Women?

Elliot Brynn in Health & Wellness November 2025 • 4 min read.

"Explore the rising concerns surrounding the overdiagnosis of Polycystic Ovary Syndrome (PCOS) and its potential impact on women's health and well-being."

Polycystic Ovary Syndrome (PCOS), first identified in the 1930s, is a common endocrine disorder affecting women of reproductive age. Over the decades, the criteria for diagnosing PCOS have broadened, leading to a significant increase in the number of women identified with the condition. This expansion raises a crucial question: Are we overdiagnosing PCOS, potentially causing more harm than good?

The original diagnostic criteria focused on specific symptoms such as amenorrhea (absence of menstruation) and infertility associated with multiple ovarian cysts. However, modern criteria, like the Rotterdam consensus, have expanded the definition to include a wider range of symptoms, including polycystic ovaries detected via ultrasound, even in the absence of other symptoms. This broader definition has led to a surge in diagnoses, sparking debate among medical professionals about potential overdiagnosis.

This article delves into the complexities surrounding PCOS diagnosis, exploring the potential pitfalls of overdiagnosis and examining the evidence for and against the current diagnostic criteria. We will consider whether the increased prevalence of PCOS diagnoses truly translates to improved health outcomes for women or if it inadvertently creates unnecessary anxiety and medical interventions.

The Shifting Sands of PCOS Diagnosis: How Criteria Have Changed

Surreal illustration symbolizing PCOS overdiagnosis

The diagnostic landscape for PCOS has evolved significantly since its initial characterization in 1935. Initially, diagnosis relied on identifying a specific set of symptoms in women experiencing infertility. Today, three different diagnostic criteria are in use, each with varying levels of inclusivity.

The National Institutes of Health (NIH) criteria, established in 1990, required both oligo-ovulation/anovulation and clinical or biochemical signs of hyperandrogenism. The 2003 Rotterdam criteria expanded upon this, requiring only two out of three criteria: oligo-ovulation/anovulation, hyperandrogenism, or polycystic ovaries on ultrasound. In 2006, the Androgen Excess and PCOS Society emphasized hyperandrogenism as a primary diagnostic factor.

1990 NIH Criteria: Requires both irregular periods and signs of high androgens.
2003 Rotterdam Criteria: Requires two of the following: irregular periods, signs of high androgens, or polycystic ovaries on ultrasound.
2006 Androgen Excess and PCOS Society Criteria: Emphasizes high androgens as a key factor, along with either irregular periods or polycystic ovaries.

This diagnostic shift has led to controversy. Critics argue that the Rotterdam criteria, in particular, may be too broad, potentially labeling women with milder symptoms as having PCOS, even if they may not experience the same long-term health risks as those with more severe forms of the condition.

A Balanced Approach: Weighing the Benefits and Harms

Ultimately, the decision to diagnose PCOS should be made on a case-by-case basis, carefully considering the individual woman's symptoms, risk factors, and concerns. A slower, stepped, or delayed approach to diagnosis, particularly in adolescents and young women with mild symptoms, may be warranted to avoid unnecessary labeling and anxiety. By promoting open communication and shared decision-making, we can ensure that women receive the best possible care, tailored to their unique needs and circumstances.

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Everything You Need To Know

What were the original diagnostic criteria for Polycystic Ovary Syndrome (PCOS), and how have they changed?

Initially, PCOS diagnosis, first identified in the 1930s, focused on specific symptoms like amenorrhea (absence of menstruation) and infertility linked to multiple ovarian cysts. Over time, criteria have broadened. The 1990 National Institutes of Health (NIH) criteria required both irregular periods and signs of high androgens. The 2003 Rotterdam criteria expanded this to include two of three criteria: irregular periods, signs of high androgens, or polycystic ovaries on ultrasound. Finally, the 2006 Androgen Excess and PCOS Society emphasized hyperandrogenism as a primary factor, alongside either irregular periods or polycystic ovaries. This shift raises concerns about potential overdiagnosis, especially with the broader Rotterdam criteria.

What are the different diagnostic criteria for PCOS, and how do they impact diagnosis?

There are three main diagnostic criteria: the 1990 NIH criteria, the 2003 Rotterdam criteria, and the 2006 Androgen Excess and PCOS Society criteria. The NIH criteria require both oligo-ovulation/anovulation and clinical/biochemical signs of hyperandrogenism. The Rotterdam criteria require two out of three: oligo-ovulation/anovulation, hyperandrogenism, or polycystic ovaries on ultrasound, potentially leading to broader diagnoses. The Androgen Excess and PCOS Society criteria emphasize hyperandrogenism along with either irregular periods or polycystic ovaries. The expansion, especially with the Rotterdam criteria, has led to more diagnoses but also to debate about whether these wider criteria accurately reflect the condition's impact on women's health, potentially leading to overdiagnosis and unnecessary anxiety.

Why is there concern about overdiagnosis of Polycystic Ovary Syndrome (PCOS)?

Concerns about overdiagnosis stem from the expanding diagnostic criteria, particularly the 2003 Rotterdam criteria. These broader criteria may include women with milder symptoms or those who may not experience the same long-term health risks. Overdiagnosis can lead to unnecessary labeling, potentially causing anxiety and prompting medical interventions that may not be required. This can create unnecessary concern, especially among younger women, without necessarily improving health outcomes. The core of the debate is whether the increased prevalence of PCOS diagnoses genuinely translates to better health for women, or if it introduces more harm than good through misdiagnosis.

What are the potential downsides of a broader diagnostic approach for Polycystic Ovary Syndrome (PCOS), such as those used in the Rotterdam criteria?

A broader diagnostic approach, exemplified by the 2003 Rotterdam criteria, carries potential downsides, primarily concerning the possibility of unnecessary labeling and anxiety. By including a wider range of symptoms, the criteria may identify women who have milder forms of the condition or who might not experience the long-term health risks typically associated with PCOS. This could lead to women receiving a diagnosis that may not be entirely accurate or reflect the severity of their condition. This can lead to unnecessary concern and potentially prompt medical interventions. This wider net might not always translate into improved health outcomes, and can inadvertently create psychological stress and increase the burden of healthcare for women.

How should healthcare professionals approach the diagnosis of Polycystic Ovary Syndrome (PCOS) to avoid potential overdiagnosis?

To avoid overdiagnosis, healthcare professionals should adopt a case-by-case approach, carefully considering an individual's symptoms, risk factors, and concerns. This might involve a slower or delayed diagnostic process, particularly in adolescents and young women with milder symptoms. Open communication and shared decision-making are crucial to ensure the best possible care, tailored to individual needs. This approach helps to balance the benefits of early detection with the potential harms of unnecessary labeling and medical interventions, allowing women to receive appropriate care without the added burden of an inaccurate diagnosis.