Table 1.
Summary of Proposed Diagnostic Criteria for PCOS in Adults
| Category | Specific Abnormality | Recommended Test | NIH | Rotterdam (2 of 3 Met) | Androgen Excess PCOS Society (Hyper-Androgenism With 1 of 2 Remaining Criteria) |
|---|---|---|---|---|---|
| Androgen status | Clinical hyperandrogenisma | Clinical hyperandrogenism may include hirsutism (defined as excessive terminal hair that appears in a male pattern) (1, 295), acne, or androgenic alopecia. | XX or |
X or |
XX or |
| Biochemical hyperandrogenisma | Biochemical hyperandrogenism refers to an elevated serum androgen level and typically includes an elevated total, bioavailable, or free serum T level. Given variability in T levels and the poor standardization of assays (31), it is difficult to define an absolute level that is diagnostic of PCOS or other causes of hyperandrogenism, and the Task Force recommends familiarity with local assays. | XX | X | XX | |
| Menstrual history | Oligo- or anovulation | Anovulation may manifest as frequent bleeding at intervals <21 d or infrequent bleeding at intervals >35 d. Occasionally, bleeding may be anovulatory despite falling at a normal interval (25–35 d). A midluteal progesterone documenting anovulation may help with the diagnosis if bleeding intervals appear to suggest regular ovulation. | XX | X | X |
| Ovarian appearance | Ovarian size/morphology on ultrasound | The PCO morphology has been defined by the presence of 12 or more follicles 2–9 mm in diameter and/or an increased ovarian volume >10 mL (without a cyst or dominant follicle) in either ovary (78). | X | X |
The Task Force suggests using the Rotterdam criteria for the diagnosis of PCOS, acknowledging the limitations of each of the three criteria (Table 2). All criteria require exclusion of other diagnoses (listed in Table 3) that cause the same symptoms and/or signs (6–9). X, may be present for diagnosis; XX, must be present for diagnosis.
Clinical or biochemical hyperandrogenism is included as one criterion in all classification systems. If clinical hyperandrogenism is present with the absence of virilization, then serum androgens are not necessary for the diagnosis. Similarly, when a patient has signs of hyperandrogenism and ovulatory dysfunction, an ovarian ultrasound is not necessary.