polycystic ovary syndrome (PCOS) diagnostic criteria

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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

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Last reviewed 07/2021

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