From the Guidelines
Polycystic Ovary Syndrome (PCOS) is diagnosed using the Rotterdam criteria, which requires at least two of three features: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound, as stated in the most recent guidelines 1.
Diagnostic Criteria
The diagnostic criteria for PCOS include:
- Oligo- or anovulation
- Clinical and/or biochemical signs of hyperandrogenism
- Polycystic ovaries on ultrasound, defined by either total ovarian volume or follicle number per ovary (FNPO) 1
Ultrasound Criteria
The ultrasound criteria for PCOS diagnosis have been revised, and the threshold for polycystic ovary morphology (PCOM) should be revised regularly with advancing ultrasound technology, with age-specific cut off values for PCOM defined 1.
- The transvaginal ultrasound approach is preferred, if sexually active and acceptable to the individual being assessed 1
- Using endovaginal ultrasound transducers with a frequency bandwidth that includes 8MHz, the threshold for PCOM should be on either ovary, a follicle number per ovary of ≥20 and/or an ovarian volume ≥ 10ml, ensuring no corpora lutea, cysts or dominant follicles are present 1
Treatment Options
Treatment depends on the patient's goals and symptoms, and may include:
- Combined hormonal contraceptives for women not seeking pregnancy
- Metformin to improve insulin sensitivity and regulate cycles
- Spironolactone for hirsutism
- Ovulation induction with clomiphene citrate or letrozole for women seeking pregnancy
- Lifestyle modifications, including a goal of 5-10% weight reduction through diet and exercise, to improve symptoms and ovulation 1
Lifestyle Modifications
Lifestyle modifications are fundamental for all patients, with a focus on:
- Weight reduction through diet and exercise
- Regular screening for metabolic complications, including glucose tolerance testing and lipid panels
- Individualized treatment based on the patient's specific symptoms, reproductive goals, and metabolic profile 1
From the Research
Diagnostic Criteria for PCOS
The diagnostic criteria for Polycystic Ovary Syndrome (PCOS) are based on the presence of two of the following criteria:
- Androgen excess
- Ovulatory dysfunction
- Polycystic ovaries 2 There are four recognized phenotypes of PCOS, each with different long-term health and metabolic implications:
- Hyperandrogenism+oligo-anovulation+polycystic ovarian morphology
- Hyperandrogenism+oligo-anovulation
- Hyperandrogenism+polycystic ovarian morphology
- Oligo-anovulation+polycystic ovarian morphology 3
Evaluation and Diagnosis
The evaluation of patients suspected of having PCOS includes:
- A thorough history and physical examination
- Assessment for the presence of hirsutism
- Ovarian ultrasonography
- Hormonal testing to confirm hyperandrogenism and oligo-anovulation as needed and to exclude similar or mimicking disorders 3 Establishing a diagnosis of PCOS is 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
Treatment Options
Treatment options for PCOS depend on the patient's phenotype, concerns, and goals, and should focus on:
- Suppressing and counteracting androgen secretion and action
- Improving metabolic status
- Improving fertility 3 Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS, while clomiphene is currently the first-line therapy for infertility 2 Metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities, but it has limited or no benefit in treating hirsutism, acne, or infertility 2 A new natural association of myo-inositol, monacolin K, and lipoic acid has been proposed as a potential treatment for PCOS, with promising results in improving hyperandrogenism and dyslipidemia 4