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Assessment/Diagnosis
➤ Diagnosis Criteria
• The 2018 International Evidence-Based Guideline recommends the
Rotterdam criteria for diagnosing PCOS, which require at least two
of the following:
▶ Clinical (hirsutism, acne, androgenic alopecia) or biochemical
hyperandrogenism
▶ Oligo- or anovulation
▶ Polycystic ovarian morphology (def ined as ≥20 follicles per ovary
or ovarian volume ≥10 cm³ by transvaginal ultrasonography).
• Obesity affects diagnostic thresholds by increasing ovarian volume
and androgen levels, while the Androgen Excess Society criteria
emphasize hyperandrogenism, identifying patients at higher
metabolic risk.
• Laboratory evaluation should include measurement of total
and free testosterone, dehydroepiandrosterone sulfate,
17-hydroxyprogesterone, thyroid-stimulating hormone, and prolactin
to exclude secondary causes. Metabolic assessment, including
glucose tolerance testing and lipid profiling, is essential given the
increased risk of diabetes mellitus and cardiovascular disease.
• PCOS is categorized into four clinical phenotypes based on the
presence or absence of hyperandrogenism, ovulatory dysfunction,
and polycystic ovarian morphology, as def ined by the Rotterdam
criteria and National Institutes of Health guidelines:
• Phenotype A (classic/full PCOS): All three diagnostic criteria;
highest metabolic risk; prominent insulin resistance and
dyslipidemia.
• Phenotype B: Hyperandrogenism and ovulatory dysfunction, but
lacks polycystic ovarian morphology; similar metabolic risks to
phenotype A.
• Phenotype C: Hyperandrogenism and polycystic ovarian
morphology despite regular ovulation, typically manifesting with
dermatologic signs rather than metabolic derangements.
• Phenotype D: Ovulatory dysfunction and polycystic ovarian
morphology without hyperandrogenism: lowest metabolic risk.
