Diagnostic Criteria

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What Are The Diagnostic Criteria for PCOS?

There are many and varied symptoms that can be related to PCOS, however the Rotterdam criteria, which arose from the joint European Society for Human Reproduction &Embryology/American Society for Reproductive Medicine Rotterdam workshop in 2003, states that in order to arrive at a diagnosis of PCOS the woman in question should have 2 or more of the following 3 clinical indicators:

Enlarged ovaries with fluid filled cysts identified via ultrasound (or laparoscopy).

Polycystic Ovaries

Hyperandrogenism which can cause symptoms such as hirsutism (hair growth on the face, buttocks, stomach, chest, back, or other places where it oughtn’t to), androgenic alopecia (loss of hair on the head), acne.
Anovulation which may or may not be accompanied by amenorrhoea and which is usually due to inapropriate gonadotropin secretion (typically an elevated LH to FSH ratio and very low progesterone levels).

Recently scientists have discovered that insulin resistance is at the heart of PCOS, and is a driving factor behind many of the symptoms and according to an article by Richard Legro, M.D. entitled Diagnostic Criteria in Polycystic Ovarian Syndrome it is being proposed that the diagnostic criteria be expanded to consider the following:

Inappropriate gonadotropin secretion
1. Elevated LH-to-FSH ratio
2. Abnormal response to GnRH agonist testing
Hyperandrogenism
1. Hirsutism, androgenic alopecia, acne
2. Hyperandrogenemia,
  1. Total testosterone
  2. Free testosterone (free androgen index, etc.)
Ovarian appearance
1. Polycystic-appearing ovaries
2. Increased (stromal) size
Insulin resistance
1. Acanthosis nigricans
2. Fasting measures of insulin/glucose
3. Oral glucose tolerance test
4. Dynamic tests of insulin sensitivity
  1. Euglycemic clamp
  2. Frequently sampled intravenous glucose tolerance test
Chronic anovulation
1. Self-reported history
2. Tests of ovulatory function
  1. Basal body temperature charting
  2. Urinary LH testing
  3. Serum progesterone measurement
  4. Endometrial biopsy