What are the diagnostic criteria for Polycystic Ovary Syndrome (PCOS) related to the uterus?

From the Guidelines

The diagnostic criteria for polycystic ovary syndrome (PCOS) do not include specific uterine findings, as PCOS primarily affects the ovaries rather than the uterus. The diagnosis of PCOS is based on the Rotterdam criteria, which require at least two of the following three features: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound 1. According to the 2014 report by the Androgen Excess and Polycystic Ovary Syndrome Society, the updated threshold for polycystic ovaries is 25 follicles, 10 mL of ovarian volume, or both 1. The transvaginal ultrasound approach is preferred in the diagnosis of PCOS, if sexually active and if acceptable to the individual being assessed, with a threshold for polycystic ovaries of ≥20 follicles and/or an ovarian volume ≥10ml 1. While the uterus itself is not part of the diagnostic criteria, women with PCOS may have a thickened endometrial lining due to unopposed estrogen from chronic anovulation, which can be detected on ultrasound 1. Key points to consider in the diagnosis of PCOS include:

• The use of transvaginal ultrasound with a frequency bandwidth that includes 8MHz 1
• The assessment of follicle number per ovary and ovarian volume 1
• The reporting of endometrial thickness and appearance, with a 3-layer endometrial assessment may be useful to screen for endometrial pathology 1
• The need for training in careful and meticulous follicle counting per ovary, to improve reporting 1

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Diagnostic Criteria for PCOS

The diagnostic criteria for Polycystic Ovary Syndrome (PCOS) involve a combination of clinical, hormonal, and metabolic factors. The following are some key points to consider:

• PCOS is a heterogeneous endocrine-metabolic syndrome characterized by ovarian dysfunction, insulin resistance, and hyperandrogenemia 2
• The diagnosis of PCOS is based on the presence of at least two of the following three features:
  • Clinical and/or biochemical signs of hyperandrogenism
  • Oligo-ovulation or anovulation
  • Polycystic ovaries on ultrasound 3
• The Rotterdam criteria, which are widely used, require the presence of at least two of the following three features:
  • Clinical and/or biochemical signs of hyperandrogenism
  • Oligo-ovulation or anovulation
  • Polycystic ovaries on ultrasound, with the exclusion of other etiologies 4
• Other diagnostic criteria, such as the National Institutes of Health (NIH) criteria, may also be used, but the Rotterdam criteria are more commonly applied 5

Uterus-Related Diagnostic Criteria

Regarding the uterus, the following points are relevant:

• Endometrial dysfunction is common in women with PCOS, and may contribute to subfertility and poor reproductive outcomes 6
• Altered uterine vascularity, immune dysfunction, and abnormal endometrial gene expression have been observed in women with PCOS 6
• The endometrium in women with PCOS may exhibit increased insulin resistance, impaired glucose transport, and chronic low-grade inflammation 6

Importance of Accurate Diagnosis

Accurate diagnosis of PCOS is crucial for both clinical care and research, as it allows for the identification of women at risk of metabolic and reproductive complications 3, 2. A comprehensive approach to diagnosis, taking into account the individual characteristics of each patient, is essential for effective management of PCOS 5.