Polycystic ovary syndrome: Where we stand with diagnosis and treatment and where we’re going

Workshop participants also agreed that a PCOS diagnosis required two of three criteria:

• oligo-ovulation or anovulation
• clinical or biochemical signs (or both) of hyperandrogenism
• polycystic ovaries on ultrasonography.

In addition, participants agreed that the exclusion of other causes of these findings—such as congenital adrenal hyperplasia, androgen-secreting tumors, Cushing’s syndrome, thyroid dysfunction, and an elevated prolactin level—was still critical to the diagnosis. (Note: We’ll discuss details of the diagnostic work-up for PCOS in a subsequent part of this article.)

The 2003 consensus meeting further described, in detail, US criteria by which to make a diagnosis of PCOS:

• at least 12 follicles in each ovary that are each 2 to 9 mm in diameter or
• ovarian volume greater than 10 mL.

These criteria do not apply to patients who are being treated with an oral contraceptive because their ovarian volume often appears smaller. In addition, having one ovary only that fits this definition was, and remains, sufficient to meet the US definition of PCOS. A so-called asymptomatic polycystic ovary—that is, positive US imaging in a woman who has regular cycles and a normal endocrine profile—should not be considered PCOS.

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