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Polycystic ovary syndrome - Management
What are the diagnostic criteria for polycystic ovary syndrome?

  • The Rotterdam diagnostic criteria have been generally accepted and state that polycystic ovary syndrome (PCOS) should be diagnosed if two of three of the following criteria are present, as long as other causes of menstrual disturbance and hyperandrogenism are excluded [Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2004; Ehrmann, 2005]:
    • Infrequent or no ovulation (usually manifested as infrequent or no menstruation).
    • Clinical or biochemical signs of hyperandrogenism (such as hirsutism, acne, or male pattern alopecia), or elevated levels of total or free testosterone.
    • Polycystic ovaries on ultrasonography, defined as the presence of 12 or more follicles in at least one ovary, measuring 2–9 mm diameter, or increased ovarian volume (greater than 10 mL).
  • Polycystic ovaries do not have to be present to make the diagnosis, and the finding of polycystic ovaries does not alone establish the diagnosis [Ehrmann, 2005].
  • The Androgen Excess and PCOS Society Task Force has challenged the Rotterdam criteria [Azziz et al, 2006; Azziz et al, 2009].
    • Only a minority of this task force considered that PCOS could exist without hyperandrogenism and suggested that PCOS should be defined by two criteria:
      • The presence of hyperandrogenism (biochemical or clinical).
      • Ovarian dysfunction (oligo- or anovulation or polycystic ovaries).
    • However, the Rotterdam consensus definition provides a helpful framework, and too exclusive a definition would leave many women with PCOS who are at the milder end of the spectrum without a diagnosis [Balen et al, 2009].

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