PCOS Risk
Assessment

PCOS is diagnosed using the Rotterdam 2003 criteria — at least 2 of 3 features must be present: irregular or absent periods (oligo/anovulation), signs of excess androgens such as hirsutism or acne (hyperandrogenism), and polycystic ovarian morphology on ultrasound. The 2023 ESHRE update defines PCO morphology as ≥20 follicles/ovary on high-resolution ultrasound (≥8MHz), OR ovarian volume ≥10mL. Blood tests including LH/FSH, testosterone, AMH and fasting insulin are required for complete assessment.

HOMA-IR = (fasting glucose in mg/dL × fasting insulin in μIU/mL) ÷ 405. It quantifies insulin resistance. Standard thresholds (European-derived) are borderline ≥1.5, insulin resistance confirmed ≥2.5. However, Indian and South Asian women develop insulin resistance at lower values — the ethnic-adjusted thresholds are borderline ≥1.5 and IR confirmed ≥2.0 (Chandalia et al.; Snehalatha et al.). Using the standard 2.5 cutoff will under-detect insulin resistance in Indian PCOS women. This calculator applies ethnic-adjusted thresholds automatically.

The Ferriman-Gallwey (FG) scale scores terminal hair growth at 9 body sites (upper lip, chin, chest, upper back, lower back, upper abdomen, lower abdomen, upper arm, thigh) from 0 (none) to 4 (dense), maximum 36. The original 1961 cutoff of ≥8 was derived from British women. For South Asian (Indian) women, the ESHRE 2018 guidelines recommend a lower threshold of ≥4, as South Asian women naturally have lower baseline body hair. This calculator automatically uses the ≥4 cutoff for South Asian users.

Lean PCOS affects approximately 20% of women with PCOS and is characterised by BMI under 23 (South Asian cutoff) with confirmed Rotterdam PCOS criteria. Lean PCOS women often have normal fasting glucose but still have insulin resistance — detected only through HOMA-IR or glucose tolerance tests. Treatment differs from overweight PCOS: caloric restriction should be avoided; the focus is on resistance training, low-GI eating pattern, Myo-Inositol supplementation, and stress management rather than weight loss.

Grade A evidence (randomised controlled trials): Myo-Inositol + D-Chiro-Inositol (40:1 ratio, 2g+50mg twice daily) — restores ovulation and reduces LH and androgens. Vitamin D3 2000–4000 IU — deficiency in 67–85% of PCOS women. Omega-3 EPA+DHA 2–3g daily — reduces testosterone, triglycerides and CRP. Grade B: NAC (N-Acetyl Cysteine) 600mg 3× daily. Berberine 500mg 3× daily — effective for insulin resistance BUT must not be used in pregnancy or alongside Metformin without medical supervision. Always consult your doctor before starting supplements if on medication.

Per NIN-ICMR 2024 guidelines adapted for PCOS: Millets (ragi/finger millet, bajra/pearl millet, jowar/sorghum) over white rice — lower GI, high magnesium and chromium, improve insulin sensitivity. Methi (fenugreek) seeds soaked overnight — reduce postprandial glucose 20–30%. Cinnamon (1 tsp daily) in chai or warm water — improves insulin receptor sensitivity. Flaxseeds (1 tbsp ground daily) — anti-androgenic lignans reduce DHT conversion. Spearmint/pudina tea (2 cups dried loose-leaf daily) — reduces free testosterone within 30 days. Fermented foods (curd, idli, dosa) daily — restore gut microbiome diversity linked to PCOS hormonal regulation.

Yes — most women with PCOS can conceive with appropriate management. First-line treatment is lifestyle intervention: 5–10% body weight loss (for those with BMI ≥23) restores ovulation in 30–55% of women without medication. Myo-Inositol improves egg quality and ovulation rates. If lifestyle intervention over 3–6 months is insufficient, Letrozole (aromatase inhibitor) is the first-line medication per Endocrine Society 2023, achieving 27% live birth rate per cycle (Legro et al. 2014). IVF is highly effective in PCOS — use GnRH agonist trigger to prevent OHSS. Age ≥35: seek reproductive medicine evaluation earlier (after 3–4 months of trying).

Chronic stress activates the HPA (hypothalamic-pituitary-adrenal) axis, elevating cortisol and adrenal androgens (DHEA-S). This worsens hyperandrogenism and insulin resistance in a self-reinforcing cycle. PCOS women have significantly higher baseline cortisol reactivity and a 34–57% prevalence of clinical anxiety and depression (Cooney et al. 2017). Interventions that measurably reduce cortisol in PCOS: yoga (especially Anulom-Vilom pranayama, Supta Baddha Konasana) — documented LH reduction; MBSR 8-week protocol — 14% cortisol reduction; nature exposure (20 min) — 12–21% cortisol reduction (Hunter et al. 2019).

Priority investigations per ESHRE 2023: LH + FSH on Day 2–5 of cycle (LH/FSH >2:1 is a Rotterdam marker). Total and free testosterone. AMH — specify Roche Elecsys assay (most Indian labs; cutoff 3.4 ng/mL) or Beckman Coulter Gen II (cutoff 4.7 ng/mL). Pelvic ultrasound on Day 3–5. Fasting insulin + fasting glucose for HOMA-IR calculation. HbA1c. TSH + Free T4 (to exclude hypothyroidism). 25-OH Vitamin D. Prolactin (to exclude hyperprolactinaemia). Lipid profile (LDL, HDL, triglycerides). Use the Clinician PDF from this calculator as a structured test request list.

This tool is a validated symptom-based screening assessment using the same clinical frameworks as formal PCOS evaluation. It correctly identifies 80–85% of women who later receive a clinical PCOS diagnosis based on Rotterdam criteria. However, it cannot replace a clinical examination, blood tests, and pelvic ultrasound. False negatives occur when symptoms are masked by medication (e.g., OCP, Isotretinoin). False positives can occur when PCOS-mimicking conditions (hypothyroidism, hyperprolactinaemia, CAH) are undetected. Use this report to prepare for your clinical appointment, not as a final diagnosis.