Surreal illustration representing PCOS diagnosis and uncertainty.

PCOS Overdiagnosis: Are We Unnecessarily Labeling Women?

Theo Raines in Health & Wellness November 2025 • 4 min read.

"Exploring the fine line between diagnosis and overdiagnosis in polycystic ovary syndrome (PCOS), and how it impacts women's health and well-being."

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, linked to infertility, metabolic issues, and psychosocial challenges. While diagnostic criteria have expanded since the 1930s, leading to increased diagnoses, concerns about potential overdiagnosis have surfaced. This raises the question: Are we unnecessarily labeling women with PCOS, and what are the implications?

The core features of PCOS include irregular periods, ovaries with cysts, and signs of high androgens (male hormones). However, these symptoms can vary significantly in severity and presentation, influenced by factors like weight, ethnicity, and environment. This variability makes diagnosis challenging, particularly in adolescents where some symptoms overlap with normal pubertal development.

This article explores the evolving landscape of PCOS diagnosis, examining the potential for overdiagnosis and its consequences. It emphasizes the importance of careful individual assessment, considering the limitations of current diagnostic criteria and the potential harms of unnecessary labeling.

The Shifting Sands of PCOS Diagnosis: How Criteria Have Changed

Surreal illustration representing PCOS diagnosis and uncertainty.

The diagnostic criteria for PCOS have evolved significantly since the condition was first described in 1935. Initially, diagnosis focused on women with amenorrhea and infertility associated with multiple ovarian cysts. Today, three different sets of criteria are in use, each with its own nuances:

The NIH Criteria (1990): Established by the National Institutes of Health, these criteria require both oligo-ovulation/anovulation and clinical or biochemical signs of hyperandrogenism.
The Rotterdam Criteria (2003): Developed at a meeting of experts in Rotterdam, these criteria broadened the definition to include two out of three features: oligo-ovulation/anovulation, hyperandrogenism, or polycystic ovaries on ultrasound.
The Androgen Excess and PCOS Society Criteria (2006): This task force emphasized hyperandrogenism as essential for diagnosis, along with either ovulatory dysfunction or polycystic ovaries.

The Rotterdam criteria, in particular, led to a significant increase in PCOS diagnoses due to the inclusion of polycystic ovaries as a diagnostic feature.

This expansion of diagnostic criteria has fueled debate, with some experts questioning the reliance on expert opinion rather than robust evidence. Concerns exist that the Rotterdam criteria, while encompassing a broader range of phenotypes, may lead to overdiagnosis and unnecessary labeling.

Moving Forward: A Call for Individualized Care

The potential for overdiagnosis in PCOS highlights the need for a more nuanced and individualized approach to diagnosis and management. While a PCOS label may benefit some women, particularly those with severe symptoms, it may cause unnecessary anxiety and distress for others. Until more definitive data emerges, clinicians should carefully weigh the benefits and harms of a PCOS diagnosis for each woman, considering her individual circumstances and preferences. A slower, stepped, or delayed approach to diagnosis, focusing on symptom management and lifestyle interventions, may be the most appropriate course of action for many, reducing the risk of unnecessary labeling and its potential negative consequences.

About this Article -

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Everything You Need To Know

What are the main features used to diagnose Polycystic Ovary Syndrome (PCOS)?

The core features used to diagnose Polycystic Ovary Syndrome (PCOS) include irregular periods (oligo-ovulation/anovulation), the presence of ovaries with cysts (polycystic ovaries), and signs of high androgens (male hormones) which can be clinical or biochemical. The specific criteria used to diagnose PCOS have evolved, with the NIH Criteria, Rotterdam Criteria, and Androgen Excess and PCOS Society Criteria each emphasizing different combinations of these features. It is important to note that the presentation of these features can vary in severity and presentation, influenced by weight, ethnicity, and environment, making diagnosis complex.

How have the diagnostic criteria for Polycystic Ovary Syndrome (PCOS) changed over time?

The diagnostic criteria for Polycystic Ovary Syndrome (PCOS) have evolved significantly since 1935. Initially, the diagnosis focused on women with amenorrhea and infertility associated with multiple ovarian cysts. Today, three sets of criteria are in use: the NIH Criteria (1990) which require oligo-ovulation/anovulation and signs of hyperandrogenism; the Rotterdam Criteria (2003) which include two out of three features: oligo-ovulation/anovulation, hyperandrogenism, or polycystic ovaries on ultrasound; and the Androgen Excess and PCOS Society Criteria (2006) which emphasize hyperandrogenism along with ovulatory dysfunction or polycystic ovaries. The Rotterdam criteria led to a notable increase in diagnoses due to the inclusion of polycystic ovaries on ultrasound as a diagnostic feature, contributing to concerns about overdiagnosis.

What are the potential harms of overdiagnosing Polycystic Ovary Syndrome (PCOS)?

Overdiagnosing Polycystic Ovary Syndrome (PCOS) can lead to unnecessary anxiety and distress for women. A PCOS label may be beneficial for some women, particularly those with severe symptoms, but for others, it can create unnecessary worry and potentially lead to inappropriate treatment. The article highlights the need to carefully weigh the benefits and harms of a PCOS diagnosis for each woman, considering individual circumstances and preferences. A slower, stepped, or delayed approach to diagnosis, focusing on symptom management and lifestyle interventions, may be appropriate for many, reducing the risk of unnecessary labeling and its potential negative consequences. The article calls for a more nuanced and individualized approach to diagnosis and management, because the same diagnosis can be harmful for some and helpful for others.

What are the key differences between the NIH, Rotterdam, and Androgen Excess and PCOS Society criteria for diagnosing Polycystic Ovary Syndrome (PCOS)?

The key differences lie in the specific features required for a Polycystic Ovary Syndrome (PCOS) diagnosis. The NIH Criteria (1990) require both oligo-ovulation/anovulation and clinical or biochemical signs of hyperandrogenism. The Rotterdam Criteria (2003) broaden the definition, including two out of three features: oligo-ovulation/anovulation, hyperandrogenism, or polycystic ovaries on ultrasound. The Androgen Excess and PCOS Society Criteria (2006) emphasize hyperandrogenism as essential, along with either ovulatory dysfunction or polycystic ovaries. The Rotterdam criteria are the broadest and have been associated with the greatest increase in diagnoses. These variations reflect different expert opinions and have implications for the number of women diagnosed with PCOS.

Why is it important to consider an individualized approach to diagnosing Polycystic Ovary Syndrome (PCOS)?

An individualized approach to diagnosing Polycystic Ovary Syndrome (PCOS) is important due to the variability in symptoms and the potential for overdiagnosis. The article emphasizes that the core features, including irregular periods, ovarian cysts, and signs of high androgens, can present differently based on factors like weight, ethnicity, and environment. Furthermore, the different diagnostic criteria (NIH, Rotterdam, Androgen Excess and PCOS Society) can lead to varying diagnoses. Considering an individualized approach is crucial because a PCOS label may not be beneficial for all women, and the potential for unnecessary anxiety and distress exists. This approach ensures that the benefits and harms of a PCOS diagnosis are carefully weighed for each woman, considering her individual circumstances, and potentially focusing on symptom management and lifestyle interventions before a definitive diagnosis is made.