A woman surrounded by ultrasound images of ovaries, symbolizing PCOS diagnosis concerns.

PCOS Overdiagnosis: Are We Unnecessarily Labeling Women?

Mira Elwood in Health & Wellness November 2025 • 4 min read.

"Explore the expanding diagnostic criteria for Polycystic Ovary Syndrome (PCOS) and the potential risks of overdiagnosis, especially for younger women and those with milder symptoms."

Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder impacting women of reproductive age, associated with infertility, metabolic, cardiovascular, and psychosocial challenges. Women may experience anovulation, irregular menstruation, polycystic ovaries, and signs of androgen excess, which vary based on factors like weight and ethnicity.

Diagnostic criteria for PCOS have broadened over time, leading to an increased number of women being diagnosed. This raises concerns about potential overdiagnosis, which could result in unnecessary disease labeling. This article addresses the potential areas of overdiagnosis and delves into the evidence and uncertainties surrounding the diagnosis and overdiagnosis of PCOS.

Originally described in 1935 through a case series involving seven women with amenorrhea and infertility linked to multiple ovarian cysts, current diagnostic criteria for PCOS include the NIH criteria established in 1990, the Rotterdam criteria that added sonographic presence of polycystic ovaries, and the Androgen Excess and PCOS Society criteria.

The Diagnostic Controversy: Expert Opinion vs. Evidence-Based Definition

A woman surrounded by ultrasound images of ovaries, symbolizing PCOS diagnosis concerns.

Both the NIH and Rotterdam criteria are primarily rooted in expert opinion, facing criticism due to limited high-quality evidence on long-term follow-up or therapeutic benefits. These limitations challenge the ability to create an evidence-based definition of the syndrome. Complicating matters further, studies often fail to differentiate between PCOS phenotypes when reporting associations between PCOS and long-term complications or treatment benefits.

Such ambiguity raises a critical question: Which women genuinely stand to benefit from treatment, and who might be at greater risk? Many studies draw from small samples of women recruited from specialist clinics, typically exhibiting more severe symptoms and classic NIH phenotypes. This approach may overestimate long-term morbidities when generalizing findings to all women with PCOS.

Including polycystic ovaries as a key diagnostic criterion has faced criticism because they are present in many women without PCOS.
Features of polycystic ovaries on ultrasonography have been found in 62-84% of women aged 18-30 in the general population and in 7% of women aged 41-45 years.

The Rotterdam criteria expanded the diagnostic net, but this assumes that a PCOS diagnosis, regardless of severity, reduces the risk of associated comorbidities and enhances fertility. For women with severe hyperandrogenism, early diagnosis and management of PCOS could potentially slow the progression of comorbidities and prevent long-term harms through early intervention.

Moving Forward: Balancing Benefits and Harms

A PCOS label might not be needed to effectively treat many symptoms of PCOS, as the label often does not change the type or intensity of the intervention. A slower, stepped, or delayed approach to diagnosis could optimize benefits and reduce harm from disease labeling, ensuring that each woman's unique circumstances are carefully considered.

About this Article -

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Everything You Need To Know

What are the main diagnostic criteria used for Polycystic Ovary Syndrome (PCOS), and how have they evolved over time?

The diagnostic criteria for Polycystic Ovary Syndrome (PCOS) have evolved since its initial description. Key criteria include the NIH criteria from 1990, the Rotterdam criteria which added the sonographic presence of polycystic ovaries, and the Androgen Excess and PCOS Society criteria. The Rotterdam criteria expanded the diagnostic net, reflecting an evolution from the initial focus on specific symptoms to include a broader range of indicators, raising questions about overdiagnosis.

Why is there concern about overdiagnosis of PCOS, and what are the potential risks associated with it?

Concerns about overdiagnosis stem from the broadening of diagnostic criteria over time. Overdiagnosis can lead to unnecessary disease labeling, potentially exposing women to treatments and interventions that may not be necessary or beneficial. The risks include the psychological impact of a diagnosis and the potential for unnecessary medical interventions and the management of a condition that may not need active intervention.

What role do polycystic ovaries play in the diagnosis of PCOS, and why is this criterion controversial?

Polycystic ovaries, as visualized through ultrasonography, are a diagnostic criterion, particularly in the Rotterdam criteria. However, this criterion is controversial because polycystic ovaries are found in a significant percentage of women in the general population who do not have PCOS. This raises concerns about whether the presence of polycystic ovaries alone accurately indicates the need for a PCOS diagnosis and subsequent treatment.

How do different diagnostic criteria, such as the NIH and Rotterdam criteria, impact the understanding and management of PCOS, and what are their limitations?

The NIH and Rotterdam criteria offer different approaches to diagnosing PCOS, which can influence how the condition is understood and managed. The NIH criteria, rooted in expert opinion, face limitations due to a lack of high-quality evidence. The Rotterdam criteria, which include sonographic presence of polycystic ovaries, expand the diagnostic net but may lead to the inclusion of women who might not benefit from treatment. Both approaches may not fully capture the variability and the implications of PCOS and risk of comorbidities, highlighting the need for more nuanced, evidence-based diagnostic approaches.

What are the implications of adopting a slower or delayed approach to diagnosing PCOS, and how could this benefit women?

A slower or delayed approach to diagnosing PCOS could optimize benefits and reduce potential harms from disease labeling. This approach would involve carefully considering each woman's unique circumstances before assigning a diagnosis. It allows for a more tailored approach to symptom management, ensuring that treatment aligns with the severity of symptoms and individual needs, rather than automatically following a diagnosis that may not always be necessary.