From the Guidelines
Polycystic Ovary Syndrome (PCOS) is diagnosed using the Rotterdam criteria, which requires at least two of three key features: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound, as stated in the most recent guidelines 1. The diagnostic criteria for PCOS involve a combination of clinical, biochemical, and ultrasound findings.
- Oligo/anovulation is defined as irregular or absent menstrual periods.
- Clinical or biochemical hyperandrogenism refers to elevated male hormones causing symptoms like acne, excess hair growth, or male-pattern hair loss.
- Polycystic ovaries on ultrasound are defined by the presence of 12 or more follicles measuring 2-9mm in diameter per ovary or an ovarian volume greater than 10mL, with recent guidelines suggesting revisions to these thresholds based on advancing ultrasound technology and age-specific cut-offs 1. Before confirming PCOS, other conditions with similar symptoms must be excluded, including thyroid disorders, hyperprolactinemia, congenital adrenal hyperplasia, androgen-secreting tumors, and Cushing's syndrome, typically involving blood tests measuring hormone levels and glucose tolerance testing 1. The diagnosis of PCOS is crucial for the management of symptoms, fertility concerns, and monitoring for associated health risks like insulin resistance, type 2 diabetes, cardiovascular disease, and endometrial cancer, with early diagnosis enabling lifestyle interventions and targeted treatments to begin promptly 1. Key aspects of PCOS diagnosis and management include:
- The use of ultrasound for diagnosis, with preferences for transvaginal ultrasound and specific thresholds for follicle number and ovarian volume 1.
- The importance of excluding other disorders that may present with similar symptoms 1.
- The role of lifestyle modification, including weight loss and dietary changes, in managing PCOS symptoms and associated health risks 1.
- The need for accurate and reliable methods for assessing biochemical hyperandrogenism, including the measurement of androgen levels and the use of reference ranges based on population characteristics 1.
From the Research
Diagnostic Criteria for PCOS
The diagnostic criteria for Polycystic Ovary Syndrome (PCOS) are based on the presence of specific clinical and biochemical features. According to the Rotterdam criteria, two out of three elements must be present:
- oligo-anovulation
- hyperandrogenism
- polycystic ovaries (defined as having at least one ovary with an ovarian volume > 10 mL and/or 12 or more follicles measuring 2 to 9 mm in diameter) 2, 3, 4
Key Features for Diagnosis
The key features for diagnosing PCOS include:
- Menstrual irregularities, such as oligomenorrhea or amenorrhea
- Signs of androgen excess, such as hirsutism
- Polycystic ovaries on ultrasound
- Exclusion of other disorders that may cause similar symptoms 2, 4, 5
Ultrasound Definition of PCOS
The ultrasound definition of PCOS contains precise criteria that must be included in the report, including:
- Presence of at least 12 follicles in each ovary measuring 2-9 mm in diameter
- And/or increase in ovary size >10 ml 2
Screening for Metabolic Abnormalities
Routine screening for metabolic abnormalities should be carried out systematically based on:
- Weight, height, and BMI
- Waist circumference
- Blood pressure
- Laboratory parameters: plasma glucose, triglycerides, HDL cholesterol 2 In the case of obesity (BMI > 30 kg/m2), oral glucose tolerance testing (OGTT) is recommended where fasting serum glucose is normal 2
Diagnosis and Management
Early detection of PCOS is crucial due to its long-term effects on metabolic and reproductive health 3, 6. A comprehensive, systematic, schematic therapy approach is crucial for the treatment of PCOS, including lifestyle modifications and various medications 3, 6.