*Geek Box: Rotterdam Criteria
The ‘Rotterdam criteria’ established a consensus in 2003 for the pathophysiological characteristics of PCOS. However, PCOS has multiple clinical manifestations, and the criteria has expanded to emphasize four distinct phenotypes:
- High androgens with clinical anovulation;
- High androgens with polycystic ovaries, but with ovulatory cycles;
- Clinical anovulation with polycystic ovaries on ultrasound, but without high androgens
- High androgens, clinical anovulation, and polycystic ovaries
It is important not to treat these criteria as set in stone; there is constant, ongoing debate in the field. For example, the presence of cysts on ovaries may not be required at all if the wider hormonal milieu is present. Nevertheless, the Rotterdam criteria is a useful heuristic to think about the complex heterogeneity of PCOS, and the differences in pathophysiology between phenotypes.