*Geek Box: The PCOS Diagnostic Criteria Tug-of-War
You may recall from previous Deepdives that we discussed what is colloquially known as the “Rotterdam criteria”, which reflected the European Society for Human Reproduction and Embryology and the American Society for Reproductive Medicine [ESHRE/ASRM] report from 2003, and included:
- High androgens with clinical oligo/anovulation [i.e., irregular/infrequent (oligo) or absence of (ano) menstrual cycles]
- High androgens with polycystic ovaries present on ultrasound, but with ovulatory cycles
- Clinical anovulation with polycystic ovaries on ultrasound, but without high androgens
- High androgens, clinical anovulation, and polycystic ovaries on ultrasound
The initial diagnostic criteria set out in 1990 by the National Institute of Health [NIH] included:
- High androgens
- Exclusion of known disorders
Compared to the 1990 NIH criteria, what the Rotterdam criteria in effect added was two new PCOS phenotypes: one defined by women with ovulatory cycles but showing polycystic ovaries combined with elevated androgens, and the other defined by women with oligo/anovulatory cycles and polycystic ovaries but without elevated androgens.
Some have argued that the introduction of these additional phenotypes was premature. Others have argued that the complexity of PCOS requires a more expansive diagnostic criterion. The heterogeneity of PCOS presentations arguably lends more weight to the latter argument.