PCOD Assessment Form

1. Have you been diagnosed with PCOD by a medical doctor in the last one year OR is your diagnosis older but you’re still under treatment for PCOD?

Yes
No

2. My Menstrual Cycle/Period is:

35 or more days apart
My periods are regular

3. I use birth control pills currently for:

contraception only
getting regular periods
I don't use birth control pills

4. Did you have an ultrasound test in the last year that showed you have polycystic ovaries OR is your positive test result older than a year but you are still undergoing treatment?

Yes
No

1. I have more hair growth than most women in one or more of these areas: face, chest, abdomen, arms, and legs.

Yes
No

2. I have acne (painful pimples) in one or more of these areas: along the jaw, lower half of the face, upper neck, and back.

Yes
No

3. My blood test reports show elevated levels of ONE OR MORE of the following male hormones:

Testosterone
DHEA-S
DHT
Androstenedione
I have not done any of these tests

4. I have significant hair loss in the front of my head or all over.

Yes
No

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PCOD Quiz