Polycystic ovarian syndrome (PCOS)
What the FAA's documents say about polycystic ovarian syndrome (PCOS), in plain words, with the FAA's own words one press away.
- The worksheet's sleep apnea box reads OSA adequately treated, noting that the applicant has a Special Issuance, and obstructive sleep apnea has its own page.
Short version
The FAA's table sorts it into three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row ALifestyle intervention only, no medication | Examiner issues | Examiner can issue |
| Row BTreated with acceptable medication(s) | Worksheet | CACI |
| Row CAll others | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Polycystic ovarian syndrome (PCOS)
- Row A · Examiner can issue
Not requiring medication; treated with lifestyle intervention only. The table says ISSUE if the examiner can determine the condition is under control, no medications are used, and there are no symptoms that would interfere with flight or safety related duties, and has the examiner annotate this information in Block 60.
A. Not requiring medication; treated with lifestyle intervention only … If the AME can determine: Condition is under control; No medications used; and No symptoms that would interfere with flight or safety related duties … ISSUE … Annotate this information in Block 60.
- Row B · CACI
Treated with acceptable medication(s). The table sends the examiner to the CACI worksheet for PCOS, and says this will require a current, detailed clinical progress note. The examiner issues with no time limitation if the pilot meets all the worksheet's criteria and is otherwise qualified, annotates the correct CACI statement in Block 60, and keeps the required supporting information on file.
B. Treated with acceptable medication(s). … See the CACI - Polycystic Ovarian Syndrome (PCOS) Worksheet. This will require a current, detailed Clinical Progress Note. If the pilot meets all CACI worksheet criteria and is otherwise qualified: … ISSUE with no time limitation … Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row C · Special Issuance
All others. The examiner submits the listed items for FAA review, defers, and submits the information to the FAA for a possible Special Issuance.
C. All others … Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance
The FAA pathways for polycystic ovarian syndrome (PCOS)
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: The progress note from the treating doctor or specialist
The note the examiner reviews, and what the treating physician finds.Within 90 days before the examA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.
The treating physician finds the condition
- Stable on the current regimen
- No side effects from medication
- Cardiovascular risk factors controlled
- No changes recommended
Show the FAA's words: The progress note from the treating doctor or specialist
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.
FAA source: CACI – PCOS Worksheet. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA
Treating physician finds the condition:
Stable on current regimen;
FAA source: CACI – PCOS Worksheet. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
Treating physician finds the condition:
No side effects from medication;
FAA source: CACI – PCOS Worksheet. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
Treating physician finds the condition:
Cardiovascular risk factors are controlled; and
FAA source: CACI – PCOS Worksheet. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
Treating physician finds the condition:
No changes recommended.
FAA source: CACI – PCOS Worksheet. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
Step 2: The worksheet's criteria
Your medications, sleep apnea, mood, diabetes and prolactinoma.Treated with the acceptable medications the worksheet lists. They may be used in combination.
The medications listed
- Anti-androgen, such as finasteride or dutasteride
- Letrozole
- Metformin
- Oral contraceptive
- Spironolactone (7-day wait)
The worksheet's other criteria
- No history of obstructive sleep apnea, or OSA adequately treated (the applicant has a Special Issuance)
- No evidence of depression or anxiety, as indicated by a current PHQ-9/GAD-7 score
- No evidence of diabetes or prolactinoma
Show the FAA's words: The worksheet's criteria
Treated with the acceptable medication(s) listed: (May be used in combination) [ ] YES
Indicate which medication(s) used:
anti-androgen (e.g., finasteride, dutasteride)
letrozole
metformin
oral contraceptive
spironolactone (7-day wait)
FAA source: CACI – PCOS Worksheet. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
History of obstructive sleep apnea [ ] No OR [ ] OSA adequately treated (Applicant has Special Issuance.)
FAA source: CACI – PCOS Worksheet. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
Any Evidence of depression or anxiety (as indicated by current PHQ-9/GAD-7 score)? [ ] No
FAA source: CACI – PCOS Worksheet. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
Any evidence of diabetes or prolactinoma? [ ] No
FAA source: CACI – PCOS Worksheet. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The table says ISSUE if the examiner can determine the condition is under control, no medications are used, and there are no symptoms that would interfere with flight or safety related duties, and has the examiner annotate this information in Block 60.
Row BWorksheetCACI
The table sends the examiner to the CACI worksheet for PCOS, and says this will require a current, detailed clinical progress note. The examiner issues with no time limitation if the pilot meets all the worksheet's criteria and is otherwise qualified, annotates the correct CACI statement in Block 60, and keeps the required supporting information on file.
Row CDefers to the FAASpecial Issuance
The examiner submits the listed items for FAA review, defers, and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Not requiring medication; treated with lifestyle intervention only. The table says ISSUE if the examiner can determine the condition is under control, no medications are used, and there are no symptoms that would interfere with flight or safety related duties, and has the examiner annotate this information in Block 60.
A. Not requiring medication; treated with lifestyle intervention only … If the AME can determine: Condition is under control; No medications used; and No symptoms that would interfere with flight or safety related duties … ISSUE … Annotate this information in Block 60.
- Row B · CACI
Treated with acceptable medication(s). The table sends the examiner to the CACI worksheet for PCOS, and says this will require a current, detailed clinical progress note. The examiner issues with no time limitation if the pilot meets all the worksheet's criteria and is otherwise qualified, annotates the correct CACI statement in Block 60, and keeps the required supporting information on file.
B. Treated with acceptable medication(s). … See the CACI - Polycystic Ovarian Syndrome (PCOS) Worksheet. This will require a current, detailed Clinical Progress Note. If the pilot meets all CACI worksheet criteria and is otherwise qualified: … ISSUE with no time limitation … Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row C · Special Issuance
All others. The examiner submits the listed items for FAA review, defers, and submits the information to the FAA for a possible Special Issuance.
C. All others … Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance
The CACI worksheet's criteria
Progress note
- Stable on the current regimen
- No side effects from medication
- Cardiovascular risk factors controlled
- No changes recommended
Your PCOS medications
The medications listed
- Anti-androgen, such as finasteride or dutasteride
- Letrozole
- Metformin
- Oral contraceptive
- Spironolactone (7-day wait)
The worksheet's other criteria
- No history of obstructive sleep apnea, or OSA adequately treated (the applicant has a Special Issuance)
- No evidence of depression or anxiety, as indicated by a current PHQ-9/GAD-7 score
- No evidence of diabetes or prolactinoma
Show the FAA's words: the CACI worksheet's criteria for Polycystic ovarian syndrome (PCOS)
- Stable on the current regimen
FAA criterion: the treating physician finds the condition stable on the current regimen.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA … Treating physician finds the condition: … Stable on current regimen;
- No side effects from medication
FAA criterion: the treating physician finds no side effects from medication.
Treating physician finds the condition: … No side effects from medication;
- Cardiovascular risk factors controlled
FAA criterion: the treating physician finds cardiovascular risk factors are controlled.
Treating physician finds the condition: … Cardiovascular risk factors are controlled; and
- No changes recommended
FAA criterion: the treating physician finds no changes recommended.
Treating physician finds the condition: … No changes recommended.
- History of obstructive sleep apnea
FAA criterion: under history of obstructive sleep apnea the worksheet's boxes are No, or OSA adequately treated, beside which it notes that the applicant has a Special Issuance.
History of obstructive sleep apnea [ ] No OR [ ] OSA adequately treated (Applicant has Special Issuance.)
- No evidence of depression or anxiety
FAA criterion: the worksheet asks whether there is any evidence of depression or anxiety, as indicated by a current PHQ-9/GAD-7 score, and the acceptable answer on it is no.
Any Evidence of depression or anxiety (as indicated by current PHQ-9/GAD-7 score)? [ ] No
- No evidence of diabetes or prolactinoma
FAA criterion: the worksheet asks whether there is any evidence of diabetes or prolactinoma, and the acceptable answer on it is no.
Any evidence of diabetes or prolactinoma? [ ] No
- Treated with the acceptable medications the worksheet lists
FAA criterion: treated with the acceptable medication(s) the worksheet lists, which may be used in combination, and the examiner indicates which are used. The list is anti-androgen (e.g., finasteride, dutasteride), letrozole, metformin, oral contraceptive, and spironolactone (7-day wait).
Treated with the acceptable medication(s) listed: (May be used in combination) [ ] YES … Indicate which medication(s) used: … anti-androgen (e.g., finasteride, dutasteride) … letrozole … metformin … oral contraceptive … spironolactone (7-day wait)
If the examiner defersSpecial Issuance
The table's last row is All others, and the table marks it DEFER.
What the FAA lists to send
- Item 1. A current, detailed clinical progress note from a clinic visit with the treating endocrinologist, OB/GYN, or treating physician no more than 90 days before the exam. The table says it must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan; prognosis; and follow-up.
- Item 2. The table says the clinical progress note must specifically include if there is any history of obstructive sleep apnea; evidence of depression or anxiety as indicated by a current PHQ-9/GAD-7 score; and/or evidence of diabetes.
- Item 3. Any other testing already completed or deemed necessary by the treating physician.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's last row is All others, and the table marks it DEFER.
C. All others … DEFER Submit the information to the FAA for a possible Special Issuance
What the FAA lists to send
- Item 1
A current, detailed clinical progress note from a clinic visit with the treating endocrinologist, OB/GYN, or treating physician no more than 90 days before the exam. The table says it must include a detailed summary of the history of the condition; current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan; prognosis; and follow-up.
A current, detailed Clinical Progress Note generated from a clinic visit with the treating endocrinologist, OB/GYN, or treating physician no more than 90 days before the AME exam. It must include: … A detailed summary of the history of the condition; … Current medications, dosage, and side effects (if any); physical exam findings; results of any testing performed; diagnosis; assessment and plan; prognosis; and follow-up.
- Item 2
The table says the clinical progress note must specifically include if there is any history of obstructive sleep apnea; evidence of depression or anxiety as indicated by a current PHQ-9/GAD-7 score; and/or evidence of diabetes.
The Clinical Progress Note must specifically include if there is any: … History of obstructive sleep apnea; … Evidence of depression or anxiety as indicated; by current PHQ-9/GAD-7 score); and/or … Evidence of diabetes.
- Item 3
Any other testing already completed or deemed necessary by the treating physician.
Any other testing already completed or deemed necessary by the treating physician.
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later exams
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Spironolactone has a 7-day wait
The worksheet's list of acceptable medications marks spironolactone with a 7-day wait.
Show the FAA's words: good to know, 2
Indicate which medication(s) used: … spironolactone (7-day wait)
Treated sleep apnea means a Special Issuance
The worksheet's box for obstructive sleep apnea that is adequately treated notes that the applicant has a Special Issuance.
Show the FAA's words: good to know, 3
History of obstructive sleep apnea [ ] No OR [ ] OSA adequately treated (Applicant has Special Issuance.)
PHQ-9 and GAD-7 scores
The worksheet asks about any evidence of depression or anxiety, as shown by a current PHQ-9/GAD-7 score. Row C of the table asks the progress note to specifically include it.
Show the FAA's words: good to know, 4
Any Evidence of depression or anxiety (as indicated by current PHQ-9/GAD-7 score)? [ ] No
The Clinical Progress Note must specifically include if there is any: … Evidence of depression or anxiety as indicated; by current PHQ-9/GAD-7 score); and/or
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Open to print: CACI – PCOS Worksheet, a PDF at the FAA, in a new tab
- Polycystic Ovarian Syndrome (PCOS) Disposition TableOpen to print: Polycystic Ovarian Syndrome (PCOS) Disposition Table, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance
- Open at the FAA: Hypothyroidism (Item 48, endocrine), a page at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Medication guidance
Medications Crosscheck lists as taken for polycystic ovarian syndrome (PCOS), each with its own page on what published FAA guidance says about it.
- Anti-androgen, acceptable medication on the FAA's PCOS worksheet
- Acceptable medication on the FAA's PCOS worksheet
- Acceptable medication on the FAA's PCOS worksheet
- Acceptable medication on the FAA's PCOS worksheet
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.