Clinical and/or biochemical signs of hyperandrogenism and exclusion of other etiologies.
Revised 2003 criteria (2 out of 3) 1.
2.
Clinical and/or biochemical signs of hyperandrogenism 3.
Polycystic ovaries and exclusion of other etiologies (congenital adrenal hyperplasia, androgen-secreting tumors, Cushing’s syndrome)
From Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:19–25, with permission.
Polycystic ovary syndrome Ancillary studies Risk assessment for endometrial carcinoma Risk assessment for glucose intolerance Fasting cholesterol, HDL cholesterol, triglycerides, LDL cholesterol Risk assessment for obstructive sleep apnea Endometrial biopsy if risk increased Oral glucose-tolerance test if risk increased Polysomnography if risk increased Two of the following disorders confirmed:  Oligomenorrhea or amenorrhea   Hyperandrogenism (hursuitism, acne, alopecia)   Hyperandrogenemia (elevated levels of free or total T)   Polycystic ovaries on ultrasound All of the following disorders ruled out:    Hyperprolactinemia    Nonclassic congenital adrenal hyperplasia    Cushing’s syndrome  Androgen-secreting neoplasm  Acromegaly Figure 31.4 Diagnostic algorithm for polycystic ovary syndrome. (From Rosenfield RL. Clinical practice. Hirsutism. N Engl J
Med 2005;353:2578–2588, with permission.) with hirsutism to exclude the presence of nonclassic congenital adrenal hyperplasia, regardless of the presence of polycystic ovaries or metabolic dysfunction (24).
The menstrual dysfunction in PCOS arises from anovulation or oligo-ovulation and ranges from amenorrhea to oligomenorrhea. Regular menses in the presence of anovulation in PCOS is uncommon, although one report found that among hyperandrogenic women with regular menstrual cycles, the rate of anovulation is 21% (25). Classically, the disorder is lifelong, characterized by abnormal menses from puberty with acne and hirsutism arising in the teens. It may arise in adulthood, concomitant with the emergence of obesity, presumably because this is accompanied by increasing hyperinsulinemia (26).
The sonographic criteria for PCO requires the presence of 12 or more follicles in either ovary measuring 2 to 9 mm in diameter and/or increased ovarian volume (>10 mL). A single ovary meeting these criteria is sufficient to affix the PCO diagnosis (19). The appearance of PCO on ultrasound scanning is common. Only a fraction of those with PCO appearance have the clinical and/or endocrine features of PCOS. A PCO appearance is found in about 23% of women of reproductive age, while estimates of the incidence of PCOS vary between 5% and 10% (27). Polycystic appearing ovaries in women with PCOS was not associated with increased cardiovascular disease risk, independent of body mass index (BMI), age, and insulin levels (28). An English study demonstrated that without symptoms of polycystic ovary syndrome, a PCO appearance alone is not associated with impaired fecundity or fertility (29).