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. The level of testosterone indicative of PCOS can vary, but biochemical hyperandrogenism is a key diagnostic criterion. According to the most recent evidence, the diagnosis of PCOS should be based on a combination of clinical, biochemical, and ultrasonographic features 1. Some key points to consider in the diagnosis and management of PCOS include:
- The Rotterdam criteria require at least two of three features: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound.
- Biochemical hyperandrogenism can be assessed through the measurement of androgens such as testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS) 1.
- The most accurate androgen measurement for detecting biochemical hyperandrogenism in PCOS is still a topic of debate, but liquid chromatography-tandem mass spectrometry (LC-MS/MS) is considered the reference standard 1.
- Management of PCOS focuses on addressing specific symptoms and long-term health risks, and may include lifestyle modifications, hormonal therapies, and fertility treatments 1.
- Lifestyle modifications, including weight loss and physical activity, can significantly improve symptoms and reduce the risk of metabolic and cardiovascular complications 1.
- Hormonal therapies, such as combined oral contraceptives and anti-androgen medications, can help regulate menstrual cycles and reduce androgen levels 1.
- Fertility treatments, such as letrozole and clomiphene citrate, may be necessary for women with PCOS who are trying to conceive 1.
From the Research
Diagnostic Criteria for PCOS
- The diagnosis of PCOS is primarily clinical, based on the presence of at least two of the three Rotterdam criteria: oligoanovulation, hyperandrogenism, and polycystic ovaries on ultrasonography 2
- PCOS is often associated with hirsutism, acne, anovulatory menstruation, dysglycemia, dyslipidemia, obesity, and increased risk of cardiovascular disease and hormone-sensitive malignancies 2
Management Options for PCOS
- Lifestyle modification, including caloric restriction and increased physical activity, is the foundation of therapy 2
- In patients who do not want to become pregnant, oral contraceptives are first-line therapy for menstrual irregularities and dermatologic complications such as hirsutism and acne 2
- Antiandrogens such as spironolactone are often added to oral contraceptives as second-line agents 2, 3, 4
- In patients who want to become pregnant, first-line therapy is letrozole for ovulation induction 2
- Metformin added to lifestyle management is first-line therapy for patients with metabolic complications such as insulin resistance 2, 3, 4
Testosterone Levels in PCOS
- Hyperandrogenism is a key feature of PCOS, and testosterone levels are often elevated 2, 5, 3, 4
- The exact level of testosterone that is indicative of PCOS is not specified, but studies have shown that reducing testosterone levels can improve symptoms of PCOS 5, 3, 4
- Atorvastatin has been shown to be effective in reducing testosterone levels in women with PCOS, and may be a useful treatment option 5