Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women. This syndrome is predominantly characterized by irregular menstrual cycles, hyperandrogenism, and characteristic findings on pelvic ultrasound. Women with PCOS also frequently suffer from metabolic dysfunction, obesity, infertility and are at an increased risk of pregnancy complications and long-term cardiovascular disease.
Revised diagnostic criteria of PCOS
1999 criteria (both 1 and 2)
1. Chronic anovulation
2. Clinical and/or biochemical signs of hyperandrogenism, and exclusion of other aetiologies
Revised 2003 criteria (2 out of 3)
1. Oligo– and/or anovulation
2. Clinical and/or biochemical signs of hyperandrogenism
3. Polycystic ovaries
and exclusion of other aetiologies (congenital adrenal hyperplasias, androgen-secreting tumours, Cushing’s syndrome)
Other Proposed Diagnostic Criteria in Polycystic Ovary Syndrome
- Inappropriate gonadotropin secretion
a) Elevated LH-to-FSH ratio
b) Abnormal response to GnRH agonist testing
2. Hyperandrogenism
a) Hirsutism, androgenic alopecia, acne
b) Hyperandrogenemia
I. Total testosterone
II. Free testosterone (free androgen index, etc.)
3. Ovarian appearance
a) Polycystic-appearing ovaries
b) Increased (stromal) size
4. Insulin resistance
a) Acanthosis nigricans
b) Fasting measures of insulin/glucose
c) Oral glucose tolerance test
d) Dynamic tests of insulin sensitivity
I. Euglycemic clamp
II. Frequently sampled intravenous glucose tolerance test
5. Chronic anovulation
a) Self-reported history
b) Tests of ovulatory function
I. Basal body temperature charting
II. Urinary LH testing
III. Serum progesterone measurement
IV. Endometrial biopsy
FSH, follicle-stimulating hormone; GnRH, gonadotropin-releasing hormone; LH, luteinizing hormone.
References:
- The Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004 Jan;19(1):41-7. [Medline]
- Legro R. Diagnostic Criteria in Polycystic Ovary Syndrome. Semin Reprod Med. 2003 Aug;21(3):267-75 [Medline]
- Reaven G. The metabolic syndrome or the insulin resistance syndrome? Different names, different concepts, and different goals. Endocrinol Metab Clin North Am. 2004 Jun;33(2):283-303. [Medline]
Created: May 10, 2005
