What are the diagnostic criteria for polycystic ovarian syndrome (PCOS)?

Updated: Sep 19, 2019
  • Author: Richard Scott Lucidi, MD, FACOG; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Answer

A 1990 expert conference sponsored by the National Institute of Child Health and Human Disease (NICHD) of the United States National Institutes of Health (NIH) proposed the following criteria for the diagnosis of PCOS:

  • Oligo-ovulation or anovulation manifested by oligomenorrhea or amenorrhea

  • Hyperandrogenism (clinical evidence of androgen excess) or hyperandrogenemia (biochemical evidence of androgen excess)

  • Exclusion of other disorders that can result in menstrual irregularity and hyperandrogenism

In 2003, the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) recommended that at least 2 of the following 3 features are required for PCOS to be diagnosed [10] :

  • Oligo-ovulation or anovulation manifested as oligomenorrhea or amenorrhea

  • Hyperandrogenism (clinical evidence of androgen excess) or hyperandrogenemia (biochemical evidence of androgen excess)

  • Polycystic ovaries (as defined on ultrasonography)

A research analysis by Copp et al pointed out that since the expanded criteria for PCOS diagnosis from the Rotterdam consensus, the estimated number of diagnoses in women of reproduction age increased from 4-6.6% to 21%. [11, 12]

The Androgen Excess and PCOS Society (AE-PCOS) published a position statement in 2006 [13] and its criteria in 2009 [14] emphasizing that, in the society’s opinion, PCOS should be considered a disorder of androgen excess, as defined by the following:

  • Clinical/biochemical evidence of hyperandrogenism

  • Evidence of ovarian dysfunction (oligo-ovulation and/or polycystic ovaries)

  • Exclusion of related disorders

The Society of Obstetricians and Gynaecologists of Canada (SOGC) indicated that a diagnosis of polycystic ovarian syndrome (PCOS) is made in the presence of at least 2 of the following 3 criteria, when congenital adrenal hyperplasia, androgen-secreting tumors, or Cushing syndrome have been excluded [3] :

  • Oligo-ovulation or anovulation

  • Clinical/biochemical evidence of hyperandrogenism

  • Polycystic ovaries on ultrasonograms (>12 small antral follicles in an ovary)


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