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2023 Guidelines confirm that, " As a sole finding, sonographically detected polycystic ovaries are not sufficient to make the diagnosis of PCOS, although they may represent a mild form of ovarian hyperandrogenism and insulin resistance."
As per available guidelines and position papers, Combined Oral Contraceptives (CoCs) are recommended as the first-line treatment in adult women with PCOS in order to regulate menses and/or improve features of hyperandrogenism. Alternatives to COCs include cyclic progestin therapy, continuous progestin therapy (progestin-only pills), or a progestin-releasing intrauterine device(IUD).
As per the 2018 International Evidence- based Guidelines from Monash: https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline: “Reliable assessment of biochemical hyperandrogenism is not possible in women on hormonal contraception, due to effects on sex hormone-binding globulin and altered gonadotrophin-dependent androgen production. Where assessment of biochemical hyperandrogenism is important in women on hormonal contraception, drug withdrawal is recommended for three months or longer before measurement, and contraception management with a non-hormonal alternative is needed during this time.”
In view of the available evidence, we can conclude that PCOS assessment cannot be performed when the patient is on any form of contraception.