Table VII.

Diagnostic assessment, diagnostic criteria and treatment of polycystic ovary syndrome (PCOS)

Diagnostic criteria	Rotterdam criteria (2 of 3) 1. Oligoovulation or irregular menstrual cycles – anovulation – < 10 cycles/year – cycle > 35 days 2. Hyperandrogenism (HA) – clinical: hirsutism, acne, androgenic alopecia – biochemical: elevated serum androgen levels 3. Polycystic ovaries (PCO) on ultrasound
Severity criteria	PCOS phenotypes: A – irregular ovulations + HA + PCO = Classic B – ovulatory dysfunction + HA C – ovulatory dysfunction + PCO D – HA + PCO Phenotype A - highest cardiometabolic risk Phenotypes B, C and D – risk proportionate to androgen levels and BMI
Basic/screening investigations	To be assessed at every appointment: – body weight – waist circumference – blood pressure To be assessed once a year: – lipid panel – fasting blood glucose – OGTT*
Specialist investigations	In selected cases: – cardiac assessment – assessing for other possible causes of hyperandrogenism – infertility assessment
Non-medical management	Low glycaemic index (GI) diet with limited intake of saturated fats (as in impaired glucose regulation) In overweight/obese patients, the recommended caloric deficit is 500–750 kcal Physical activity –minimum 150 min of aerobic activity per week; 200–300 min in patients with obesity Psychological support Smoking cessation
Medical management	Patients with insulin resistance: metformin In patients with BMI ≥27 kg/m2 consider the GLP-1RA approved for the management of overweight and obesity

^*In women with BMI > 30 kg/m² and all women > 40 years of age, history of gestational diabetes and/or family history of T2D. BMI – body mass index, GLP-1RA – glucagon-like peptide-1 receptor agonist, OGTT – oral glucose tolerance test, PCOS – polycystic ovary syndrome.