From the Guidelines
The diagnostic criteria for Polycystic Ovary Syndrome (PCOS) should be based on the Rotterdam criteria, which require at least two of three key features: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound, with careful consideration of the limitations and challenges associated with ultrasound diagnosis, as highlighted in recent international guidelines 1.
Key Features of PCOS Diagnosis
- Oligo/anovulation typically presents as irregular menstrual cycles (fewer than 8 cycles per year or cycles longer than 35 days)
- Hyperandrogenism can manifest clinically as hirsutism, acne, or male-pattern hair loss, or biochemically as elevated testosterone levels
- Polycystic ovaries are defined as having a follicle number per ovary of ≥20 and/or an ovarian volume ≥ 10ml, ensuring no corpora lutea, cysts or dominant follicles are present, as recommended by recent international guidelines 1
Considerations for Ultrasound Diagnosis
- Ultrasound should not be used for the diagnosis of PCOS in those with a gynaecological age of < 8 years (< 8 years after menarche), due to the high incidence of multi-follicular ovaries in this life stage 1
- The transvaginal ultrasound approach is preferred in the diagnosis of PCOS, if sexually active and if acceptable to the individual being assessed 1
- Clear protocols are recommended for reporting follicle number per ovary and ovarian volume on ultrasound, including minimum reporting standards such as last menstrual period, transducer bandwidth frequency, and approach/route assessed 1
Importance of Comprehensive Evaluation
- Before diagnosing PCOS, other conditions with similar presentations must be excluded, including thyroid disorders, hyperprolactinemia, congenital adrenal hyperplasia, androgen-secreting tumors, and Cushing's syndrome 1
- This typically involves blood tests for thyroid function, prolactin levels, 17-hydroxyprogesterone, and cortisol
- PCOS is a diagnosis of exclusion, and comprehensive evaluation is necessary because it has significant implications for fertility, metabolic health, and long-term cardiovascular risk 1
From the Research
Diagnostic Criteria for PCOS
The diagnostic criteria for Polycystic Ovary Syndrome (PCOS) include two out of three features:
- Androgen excess
- Menstrual irregularity
- Polycystic ovary appearance on ultrasound (PCO) 2, 3, 4 These criteria are based on the Rotterdam criteria, which have been used since 2004 to diagnose PCOS 4.
Key Features of PCOS
The key features of PCOS include:
- Hyperandrogenism
- Oligoanovulation
- Polycystic ovaries on ultrasonography 2, 3, 5 These features are often associated with other symptoms such as hirsutism, acne, anovulatory menstruation, dysglycemia, dyslipidemia, obesity, and increased risk of cardiovascular disease and hormone-sensitive malignancies 3.
Diagnosis and Management
The diagnosis of PCOS is primarily clinical, based on the presence of at least two of the three Rotterdam criteria 3. Management decisions depend on the patient's desire for pregnancy, and may include lifestyle modification, oral contraceptives, antiandrogens, and metformin therapy 2, 3, 6. It is recommended to screen for depression and obstructive sleep apnea in patients with PCOS 3.