Polycystic%20ovarian%20syndrome Diagnosis
Diagnosis
- Diagnosis is based on 2003 Rotterdam criteria:
- 2 out of 3 of the following: Oligo-ovulation or anovulation, clinical or biochemical signs of hyperandrogenism, polycystic ovaries
- Exclusion of other causes (congenital adrenal hyperplasia, androgen-secreting tumors, Cushing’s syndrome, thyroid disease, prolactinoma)
- Androgen Excess PCOS Society guidelines cite hyperandrogenism as an absolute requirement for diagnosis
History
- Focus on the onset and duration of various signs of androgen excess, menstrual history and concomitant medications eg exogenous androgens
- Menstrual history must screen for the status of ovulation in women with PCOS seeking fertility
- Family history of DM or cardiovascular disease (CVD) (especially 1st-degree relatives with premature onset of CVD)
Physical Examination
- Patients usually have features of hyperandrogenism and chronic anovulation; cutaneous symptoms of PCOS should be documented
- Visual scales such as the modified Ferriman Gallwey score (mFG) for hirsutism and the Ludwig visual score for alopecia may be used during evaluation
- Body mass index (BMI) and waist-hip ratio are calculated
- Blood pressure
Laboratory Tests
- Urine pregnancy test should be obtained in every patient in the reproductive age group reporting for menstrual abnormalities
- If the patient presents with clinical features of hyperandrogenism with chronic anovulation, then other identifiable causes need to be excluded
- Biochemical hyperandrogenism may be evaluated by measuring total or free testosterone or free androgen index using chromatography assays
- If total or free testosterone levels are not increased, consider measuring androstenedione and dehydroepiandrosterone (DHEAS), though additional information from these is limited
- Patient should undergo lab tests to exclude:
- Androgen-secreting tumors of the ovary or adrenal gland, late-onset congenital adrenal hyperplasia, and hyperprolactinemia
- The above can be ruled out if prolactin, TSH, free testosterone, DHEAS and corticotropin-stimulated 17-α-hydroxyprogesterone levels are normal
- Oral glucose tolerance test (OGTT) determines the degree of glucose tolerance and hyperinsulinemia
- Lipid profile
- Midluteal serum progesterone may be done to document potential anovulation in PCOS patients with regular menses
Imaging
Ultrasonography
- Used in the diagnosis of PCOS in patients who are 8 years past their menarche because a high incidence of multifollicular ovaries is seen in females with a gynecological age of <8 years
- Transvaginal ultrasound is the preferred approach if acceptable to the patient and if sexually active
- Determination of polycystic ovaries in one or both ovaries:
- Endovaginal ultrasound findings of ≥20 follicles measuring 2-9 mm in diameter per ovary and/or increased ovarian volume (≥10 cm3) on either ovary; transabdominal ultrasound finding of an ovarian volume ≥10 cm3 due to difficulty of follicle counting
- If there is a follicle >10 mm in diameter, the scan should be repeated at a time of ovarian quiescence in order to calculate volume and area
- Presence of one polycystic ovary is sufficient to provide the diagnosis
- Identification of endometrial abnormalities
- Routine screening with ultrasound for endometrial thickness to rule out endometrial cancer in PCOS patients is not recommended