Guidelines from the Endocrine Society recommend using the Rotterdam criteria for the diagnosis of PCOS. The Rotterdam criteria mandate the presence of 2 of the following three findings: hyperandrogenism, ovulatory dysfunction, and polycystic ovaries—plus the exclusion of other diagnoses that could result in hyperandrogenism or ovulatory dysfunction.
Diagnosis of PCOS is based on 2 of 3 Rotterdam Criteria:
1. Hyperandrogenism – either clinically by skin manifestations of androgen excess OR hyperandrogenemia (high testosterone in a blood test).
2. Ovulation dysfunction (i.e. Oligo/Anovulation)
3. Polycystic ovaries on ultrasound.
AND
Exclusion of phenotypically similar androgen excess disorders such as congenital adrenal hyperplasia (CAH), androgen-secreting tumors, Cushing syndrome, thyroid dysfunction, and hyperprolactinemia.
| Criteria | Explaination |
| Hyperandrogenism | -Diagnosed clinically by the presence of excessive acne, androgenic alopecia, or hirsutism (terminal hair in a male pattern distribution); or chemically, by high serum levels of total, bioavailable, or free testosterone or dehydroepiandrosterone sulfate. “Measurement of androgen levels is helpful in the rare occasion that an androgen-secreting tumor is suspected (e.g., when a patient has marked virilization or rapid onset of symptoms associated with PCOS).” |
| Ovulation Dysfunction (Oligo/Anovulation) | Oligomenorrhea = cycles more than 35 days apart but less than 6 months apart Amenorrhea = absence of menstruation for 6 to 12 months after a cyclic pattern has been established |
| Polycystic Ovaries on Ultrasound | “A polycystic ovary is defined as an ovary containing 12 or more follicles (or 25 or more follicles using new ultrasound technology) measuring 2 to 9 mm in diameter or an ovary that has a volume of greater than 10 mL on ultrasonography. A single ovary meeting either or both of these definitions is sufficient for the diagnosis of polycystic ovaries.” However, “ultrasonography of the ovaries is unnecessary unless imaging is needed to rule out a tumor or the patient has met only one of the other Rotterdam criteria for PCOS. Polycystic ovaries meeting the above parameters can be found in as many as 62% of patients with normal ovulation, with prevalence declining as patients increase in age.” |
| AND Exclusion of phenotypically similar androgen excess disorders | -such as congenital adrenal hyperplasia (CAH), androgen-secreting tumors, Cushing syndrome, thyroid dysfunction, and hyperprolactinemia. |
Because oligomenorrhea is common right after menarche, it is reasonable to delay evaluation for PCOS in adolescent patients until two years after menarche. “For this age group, it is also recommended that all three Rotterdam criteria be met before the diagnosis is made. Patients who have marked virilization or rapid onset of symptoms require immediate evaluation for a potential androgen-secreting tumor.” AAFP
References
http://www.aafp.org/afp/2016/0715/p106.html
Presentation by Dr. Maher Abdallah, FACOG at UCR Palm Springs in November 2016