Diagnostic Criteria for Polycystic Ovary Syndrome: Pitfalls and Controversies

Abstract

It is estimated that as many as 1.4 million Canadian women may be afflicted with polycystic ovary syndrome (PCOS). Although PCOS is heralded as one of the most common endocrine disorders occurring in women, its diagnosis, management, and associated long-term health risks remain controversial. Historically, the combination of androgen excess and anovulation has been considered the hallmark of PCOS. To date, while these symptoms remain the most prevalent among PCOS patients, neither is considered an absolute requisite for the syndrome. Inclusion of ultrasonographic evidence of polycystic ovaries as a diagnostic marker has substantially broadened the phenotypic spectrum of PCOS, yet much debate surrounds the validity of these newly identified milder variants of the syndrome. Difficulty in resolving the spectrum of PCOS stems from the continued use of inconsistent and inaccurate methods of evaluating androgen excess, anovulation, and polycystic ovaries on ultrasound. At present, there is no clear-cut definition of biochemical hyperandrogenemia, particularly since we depend on poor laboratory standards for measuring androgens in women. Clinical signs of hyperandrogenism are ill-defined in women with PCOS, and the diagnosis of both hirsutism and polycystic ovarian morphology remains alarmingly subjective. Lastly, there is an inappropriate tendency to assign ovulatory status solely on the basis of menstrual cycle history or poorly timed endocrine measurements. In this review, we elaborate on these limitations and propose possible resolutions for clinical and research settings. By stimulating awareness of these limitations, we hope to generate a dialogue aimed at solidifying the evaluation of PCOS in Canadian women.

A cross sectional study of polycystic ovarian syndrome among young women in Bhopal, Central India

“…12 Diagnosis of PCOS is now largely based on the Rotterdam criteria, which are inclusive of the original National Institutes of Health (NIH) criteria and require two of three key features: oligo-or anovulation, clinical and/or biochemical hyperandrogenism and polycystic ovaries on ultrasound. 13 In approximately 20% of the cases, it may be incidentally found on ultrasound examination in asymptomatic patients . 14 In most of time dilemma of diagnosis and treatment modalities exists.…”

Contribution of real-time elastography in diagnosis of polycystic ovary syndrome

“…In addition to insulin resistance, serum androgenic hormone levels are increased, causing undesired effects on women's metabolic, reproductive, and cardiovascular health (1)(2)(3)(4)(5). PCOS is characterized by enlarged ovaries containing small cysts, for which the syndrome was named (6).…”

Introductory Chapter: Polycystic Ovarian Disease: The Rainbow Without Color (SPECTRUM)

“…The diagnostic criteria can be dated back to 1990, when National Institute of Child Health and Human Development (NICHD) gave the irst working diagnostic criteria [1].The NICHD criteria was based on majority opinion and was not on clinical trial [2]. Polycystic morphology of the ovaries was a consistent inding in women demonstrating biochemical and clinical evidence of the syndrome [3][4][5][6] Fulilling two of three diagnostic criteria implies that PCOS can be diagnosed in the absence of androgen excess or menstrual irregularity-the very factors that were once considered absolute requisite for the syndrome [7]. Task force appointed by the Androgen Excess and PCOS society in 2006 considered the menstrual disorder and the ultrasonography inding of polycystic ovaries to be the presentation of similar pathophysiology and considered them to be one.…”

“…Task force appointed by the Androgen Excess and PCOS society in 2006 considered the menstrual disorder and the ultrasonography inding of polycystic ovaries to be the presentation of similar pathophysiology and considered them to be one. At present, there is no deinitive diagnostic criteria for polycystic ovarian disease rather it is a diagnosis of exclusion [7]. For evaluation of hyperandrogenemia, there is no consensus about which testosterone to be measured, when to be measured, what range should be taken, and what method of measurement is to be used.…”