From the Guidelines
Polycystic ovary syndrome (PCOS) should be diagnosed based on the International Evidence-based Guideline Criteria, which requires two of either ovulatory dysfunction, clinical or biochemical hyperandrogenism, and/or polycystic ovary morphology (PCOM) on ultrasound or elevated anti-Müllerian hormone levels. The diagnosis of PCOS typically begins with a detailed medical history and physical examination to assess for signs of hyperandrogenism, such as hirsutism, acne, or androgenic alopecia, as well as ovulatory dysfunction 1.
Diagnostic Criteria
The diagnostic criteria for PCOS include:
- Ovulatory dysfunction
- Clinical or biochemical hyperandrogenism
- Polycystic ovary morphology (PCOM) on ultrasound or elevated anti-Müllerian hormone levels Blood tests to measure hormone levels, including testosterone, DHEAS, FSH, LH, prolactin, and thyroid function, are also essential in the diagnostic workup of PCOS 1.
Importance of Accurate Diagnosis
Accurate diagnosis of PCOS is crucial, as it increases the risk of developing type 2 diabetes, cardiovascular disease, endometrial cancer, and infertility 1. Early diagnosis and treatment can help mitigate these risks and improve quality of life.
Diagnostic Challenges
The detection of hyperandrogenism in women with PCOS can be challenging due to the limitations of current diagnostic methods, including immunoassay methods and liquid chromatography-tandem mass spectrometry (LC-MS/MS) 1. Therefore, a comprehensive diagnostic approach that takes into account the patient's medical history, physical examination, and laboratory results is necessary to establish an accurate diagnosis of PCOS.
Treatment and Management
Treatment of PCOS is individualized based on symptoms and whether pregnancy is desired, often including lifestyle modifications, hormonal contraceptives, anti-androgen medications, and metformin for insulin resistance 1. A thorough understanding of the diagnostic criteria and challenges is essential for providing effective treatment and management of PCOS.
From the Research
PCOS Diagnosis Criteria
- The diagnosis of PCOS is based on the presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries, as suggested by the Rotterdam criteria 2.
- The National Institutes of Health (NIH) 1990, Rotterdam 2003, and the Androgen Excess Society 2006 criteria are also used to diagnose PCOS, with slightly different permutations of the principal features of the syndrome, including hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology 3.
- The diagnosis of PCOS is a diagnosis of exclusion, with other androgen excess and ovulatory dysfunction disorders to be ruled out 3.
Diagnostic Challenges
- Establishing a diagnosis of PCOS can be problematic in adolescents and menopausal women, as hyperandrogenism is central to the presentation in adolescents, whereas there is no consistent phenotype in postmenopausal women 2.
- The diverse features of PCOS have led to a number of diagnostic criteria over the years, causing confusion surrounding PCOS diagnosis 4.
Evaluation and Treatment
- Evaluation of women with PCOS should exclude alternate androgen-excess disorders and risk factors for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease 2.
- Treatment options for PCOS include oral contraceptive pills, antiandrogens, and metformin, with hormonal contraceptives being the first-line management for menstrual abnormalities and hirsutism/acne in PCOS 2, 5.
- Clomiphene is currently the first-line therapy for infertility, while metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities 2.