This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Polycystic ovary syndrome (PCOS) diagnostic criteria

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Thyroid dysfunction, congenital adrenal hyperplasia, hyperprolactinaemia, androgen-secreting tumours and Cushing’s syndrome must to be excluded before making a diagnosis of PCOS (1).

NICHD (1990) Diagnostic Criteria for PCOS is:

Clinical Hyperandrogenism (Ferriman-Gallwey Score >8) or Biochemical Hyperandrogenism (Elevated Total/Free Testosterone) AND

Oligomenorrhea (Less Than 6-9 Menses per Year) or Oligo-Ovulation AND

Polycystic Ovaries on Ultrasound (>= 12 Antral Follicles in One Ovary or Ovarian Volume >= 10 cm3)

 

Rotterdam (2003) Diagnostic criteria for PCOS - two out of three of:

Clinical Hyperandrogenism (Ferriman-Gallwey Score >8) or Biochemical Hyperandrogenism (Elevated Total/Free Testosterone) OR

Oligomenorrhea (Less Than 6-9 Menses per Year) or Oligo-Ovulation OR

Polycystic Ovaries on Ultrasound (>= 12 Antral Follicles in One Ovary or Ovarian Volume >= 10 cm3)

 

AE-PCOS Society (2009) Diagnostic Criteria for PCOS is:

Clinical Hyperandrogenism (Ferriman-Gallwey Score >8) or Biochemical Hyperandrogenism (Elevated Total/Free Testosterone) PLUS Either of:

Oligomenorrhea (Less Than 6-9 Menses per Year) or Oligo-Ovulation OR

Polycystic Ovaries on Ultrasound (>= 12 Antral Follicles in One Ovary or Ovarian Volume >= 10 cm3)

  • at the National Institutes of Health (NIH) consensus conference held in 1990, PCOS was defined as chronic anovulation with clinical and/or biochemical hyperandrogenism, with exclusion of other mimicking aetiologies, such as thyroid or adrenal dysfunction

  • in 2003, the Rotterdam European Society for Human Reproduction/American Society of Reproductive Medicine (ESHRE/ASRM)-sponsored PCOS consensus workshop group proposed that the diagnosis include two of the following three criteria:
    • oligo- and/or anovulation
    • clinical and/or biochemical hyperandrogenism
    • and polycystic ovaries on ultrasound; other etiologies must be excluded
    • by adding the polycystic ovaries criterion, the Rotterdam definition extended the diagnosis of PCOS to women with oligo-ovulation and polycystic ovaries (nonhyperandrogenic), as well as to women with hyperandrogenism and polycystic ovaries (ovulatory), both of whom would not have met the narrower NIH criteria for PCOS
      • has been argued that the expanded Rotterdam criteria can result in an overdiagnosis or misdiagnosis of PCOS; also different phenotypes may not have similar risks of long-term metabolic morbidities

  • in 2009, the Androgen Excess and PCOS (AE-PCOS) Society published a task force report emphasizing that PCOS is primarily a hyperandrogenic disorder and proposed revising the definition to
    • hyperandrogenism (hirsutism and/or hyperandrogenemia) and ovarian dysfunction (oligo-anovulation and/or polycystic ovaries)
    • thereby encompassing the Rotterdam ultrasound criteria but requiring hyperandrogenism for the diagnosis

  • PCOS task force recommends to utilize either follicle number per ovary (>=25) when a sophisticated US transducer >= 8MHz is available or, otherwise, an ovarian volume of >=10 ml to define PCOS morphology (5)

Suggested differential diagnoses and screening tests (6)

  • pregnancy - pregnancy test

  • hypothyroidism - TSH

  • hyperprolactinemia - PRL

  • late-onset CAH (congenital adrenal hyperplasia) - 17-hydroxyprogesterone
    • an early-morning, early follicular-phase plasma level of 17-hydroxyprogesterone of less than 200 ng per deciliter effectively rules out 21-hydroxylase deficiency, which is the most common cause of nonclassic congenital adrenal hyperplasia (6)

  • ovarian tumor - total testosterone

  • hyperthecosis - total testosterone

  • adrenal tumor - dehydroepiandrosterone sulfate (DHEAS)

  • Cushing's syndrome - 24-hour urine free cortisol

Reference:


Related pages

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.