What are the diagnostic criteria for Polycystic Ovary Syndrome (PCOS) in primary care settings?

From the Guidelines

Diagnosing PCOS in primary care settings requires a comprehensive approach based on the Rotterdam criteria, which includes at least two of the following three criteria: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound, as recommended by the most recent guidelines 1. To diagnose PCOS, a detailed history focusing on menstrual irregularities, hirsutism, acne, and fertility concerns should be taken.

• Physical examination should assess for signs of hyperandrogenism such as hirsutism using the Ferriman-Gallwey score, acne, and androgenic alopecia, as well as checking BMI and blood pressure.
• Laboratory testing should include total testosterone, free testosterone, DHEAS, androstenedione, 17-hydroxyprogesterone, TSH, prolactin, FSH, LH, and fasting glucose and insulin levels. A transvaginal ultrasound (if available in primary care) can identify polycystic ovarian morphology, defined as 12 or more follicles measuring 2-9mm in diameter in at least one ovary or ovarian volume greater than 10mL, as supported by recent studies on ultrasonographic criteria 1. It's essential to rule out other conditions that mimic PCOS, including thyroid disorders, hyperprolactinemia, congenital adrenal hyperplasia, and Cushing's syndrome.
• Early diagnosis is crucial as PCOS increases risks for type 2 diabetes, cardiovascular disease, endometrial cancer, and infertility, allowing for timely intervention and management of both reproductive and metabolic aspects of the syndrome. The use of anti-Müllerian hormone (AMH) in PCOS diagnosis has also been reviewed, providing insights into its potential role in informing international guidelines 1. However, the most recent and highest quality study 1 prioritizes the Rotterdam criteria and emphasizes the importance of a comprehensive approach in diagnosing PCOS.

From the Research

Diagnosis of PCOS in Primary Care Settings

• The diagnosis of Polycystic Ovary Syndrome (PCOS) in primary care settings involves a comprehensive assessment of the patient's symptoms, medical history, and physical examination 2.
• Primary care physicians play a crucial role in the diagnosis, assessment, and management of PCOS, and optimal management requires equitable access to primary care 2.
• The diagnosis of PCOS is based on the presence of hyperandrogenism, chronic anovulation, and insulin resistance, which can manifest as hirsutism, acne, and irregular menstrual cycles 3.

Clinical Characteristics of PCOS

• The clinical characteristics of PCOS include hyperandrogenism, chronic anovulation, insulin resistance, and infertility 3.
• Hyperandrogenism is generally manifested as hirsutism and acne, which can be treated with similar drug therapies, including oral contraceptive pills, topical medications, and antiandrogens 4, 3.
• The severity of hirsutism can be quantified using the modified Ferriman-Gallwey score, which is a useful tool in assessing the response to treatment 5.

Diagnostic Criteria for PCOS

• The diagnosis of PCOS is based on composite criteria, which include the presence of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries on ultrasound 6.
• The current guidelines for diagnosing PCOS emphasize the importance of accurate diagnosis for both clinical care and research 6.
• A thorough medical history, physical examination, and laboratory tests are essential in diagnosing PCOS and ruling out other conditions that may mimic its symptoms 2.