September, also observed as PCOS Awareness Month, is also a reminder that understanding Polycystic Ovary Syndrome (PCOS) is not always as straightforward as looking at an ultrasound report. As medical understanding evolves, Anti-Müllerian Hormone, or AMH, a blood test linked to ovarian follicles, is finding a growing place in the conversation around PCOS diagnosis. However, doctors stress that it is an additional tool rather than a shortcut to diagnosis.
For Dr Krupa Patalay, senior consultant, gynaecology at Fernandez Hospital, understanding PCOS begins with recognising what the condition actually is. “PCOS is basically a hormonal imbalance that throws off the menstrual cycle. It’s not a disease in the way people usually mean that word. It’s more of a disturbance in normal physiology, and a few different things can set it off,” she says.
AMH reflects the pool of developing follicles in the ovaries, which helps explain its connection with PCOS. Dr Ravi Sankar Erukulapati, senior consultant Endocrinologist at Apollo Hospitals, Jubilee Hills, explains, “AMH is produced by small ovarian follicles and reflects the pool of developing follicles.”
The newer international guidelines have brought attention to how AMH can sometimes be used alongside the existing diagnostic process. Dr Krupa shares, “AMH was never meant to replace the full picture, and it still isn’t required to diagnose PCOS. What the newer guidelines actually say is that a high AMH reading can stand in for ultrasound when a good quality scan isn’t available. That matters in places with limited equipment or where the person doing the scan doesn’t have much experience. A well-done ultrasound is still the gold standard, especially when you’re also looking at irregular cycles and signs of excess androgen.”
There are practical reasons why a blood test can be appealing, particularly when access to reliable imaging is uneven. Dr Ravi adds, “AMH levels are often elevated in PCOS because the ovaries may contain a larger number of small follicles, which produce AMH. Higher levels can indicate increased follicle activity and help doctors understand ovarian characteristics. However, AMH alone cannot confirm PCOS, as levels overlap with those seen in women without PCOS.”
That distinction becomes important because an AMH result can be influenced by several factors. “People hear ‘blood test instead of ultrasound’ and assume it’s a simple swap, but AMH still has to be read alongside irregular cycles, signs of hyperandrogenism, and the patient’s history. Where AMH really earns its place is with women already in fertility treatment who aren’t responding to standard ovulation induction. A very high number there often explains what’s going wrong and tells the doctor it’s time to change approach,” Dr Krupa narrates.
Age and other factors can also affect how the result should be understood. Dr Ravi notes, “AMH naturally changes with age, generally declining as ovarian reserve decreases. Levels may also be influenced by hormonal contraception, ovarian conditions and laboratory methods. Therefore, patients should avoid interpreting an AMH result in isolation. Doctors consider age, menstrual history, symptoms, ultrasound findings and hormone tests before drawing conclusions about PCOS.”
A wider health assessment remains essential because PCOS can involve more than reproductive symptoms. Dr Ravi expresses, “Because PCOS affects hormones and metabolism, evaluation may include blood glucose or HbA1c, lipid profile, blood pressure and, when appropriate, thyroid, prolactin and androgen testing. Doctors also assess weight, menstrual patterns and risk factors. These checks help identify insulin resistance, diabetes, cardiovascular risks and hormonal imbalances that may accompany PCOS.”
For Dr Krupa, awareness should also help women avoid unnecessary fear around fertility. “Having PCOS doesn’t mean a woman can’t get pregnant. It usually means ovulation is irregular, so it can take longer than expected, and sometimes medication is needed to help it along. That’s a completely different situation from infertility, and mixing the two up causes a lot of unnecessary panic,” she notes.
For long-term wellbeing, Dr Ravi encourages women to seek professional guidance rather than trying to interpret symptoms themselves. “PCOS is manageable when recognised early. Women with irregular periods, excess hair growth, acne, weight changes or fertility concerns should seek medical advice, not self-diagnose. Timely treatment can improve symptoms, fertility and metabolic health. Regular follow-up, healthy lifestyle measures and care are important for long-term wellbeing and prevention of complications,” he concludes.