Diagnosis of polycystic ovary syndrome in adults
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- David A Ehrmann, MD
David A Ehrmann, MD
- Professor of Medicine
- University of Chicago
The polycystic ovary syndrome (PCOS) is an important cause of both menstrual irregularity and androgen excess in women. When fully expressed (for example, in women with hirsutism, irregular menstrual cycles, obesity, and a classic ovarian morphology on transvaginal ultrasound), PCOS can be readily diagnosed. However, there has been considerable controversy about specific diagnostic criteria when not all of these classic features are evident.
The diagnosis of PCOS will be reviewed here. The epidemiology and pathogenesis, clinical manifestations, and treatment of PCOS are described in detail separately. (See "Epidemiology and pathogenesis of the polycystic ovary syndrome in adults" and "Clinical manifestations of polycystic ovary syndrome in adults" and "Treatment of polycystic ovary syndrome in adults".)
The clinical features of PCOS are described here briefly but are reviewed in detail separately. (See "Clinical manifestations of polycystic ovary syndrome in adults".)
PCOS is thought to be one of the most common endocrinopathies in women, affecting between 6.5 and 8 percent of women overall. The syndrome is characterized clinically by oligomenorrhea and hyperandrogenism, as well as the frequent presence of associated risk factors for cardiovascular disease, including obesity, glucose intolerance, dyslipidemia, and obstructive sleep apnea. Other features include:
●Menstrual dysfunction – The menstrual irregularity typically begins in the peripubertal period, and menarche may be delayed. The menstrual pattern is typically oligomenorrhea (fewer than nine menstrual periods in a year) and, less often, amenorrhea (no menstrual periods for three or more consecutive months). Women with PCOS often experience more regular cycles after age 40 years. (See "Clinical manifestations of polycystic ovary syndrome in adults", section on 'Menstrual dysfunction'.)
- Carmina E, Koyama T, Chang L, et al. Does ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992; 167:1807.
- Polson DW, Adams J, Wadsworth J, Franks S. Polycystic ovaries--a common finding in normal women. Lancet 1988; 1:870.
- Adams J, Polson DW, Franks S. Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J (Clin Res Ed) 1986; 293:355.
- Johnstone EB, Rosen MP, Neril R, et al. The polycystic ovary post-rotterdam: a common, age-dependent finding in ovulatory women without metabolic significance. J Clin Endocrinol Metab 2010; 95:4965.
- Randeva HS, Tan BK, Weickert MO, et al. Cardiometabolic aspects of the polycystic ovary syndrome. Endocr Rev 2012; 33:812.
- Veltman-Verhulst SM, Boivin J, Eijkemans MJ, Fauser BJ. Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and meta-analysis of 28 studies. Hum Reprod Update 2012; 18:638.
- Dokras A, Clifton S, Futterweit W, Wild R. Increased prevalence of anxiety symptoms in women with polycystic ovary syndrome: systematic review and meta-analysis. Fertil Steril 2012; 97:225.
- Dokras A, Clifton S, Futterweit W, Wild R. Increased risk for abnormal depression scores in women with polycystic ovary syndrome: a systematic review and meta-analysis. Obstet Gynecol 2011; 117:145.
- Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19:41.
- Dewailly D, Lujan ME, Carmina E, et al. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2014; 20:334.
- Alsamarai S, Adams JM, Murphy MK, et al. Criteria for polycystic ovarian morphology in polycystic ovary syndrome as a function of age. J Clin Endocrinol Metab 2009; 94:4961.
- Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: Towards a rational approach. In: Polycystic Ovary Syndrome (Current Issues in Endocrinology and Metabolism), Dunaif A, Givens JR, Haseltine FP, Merriam GE (Eds), Blackwell Scientific Inc., Boston 1992. p.377.
- Azziz R, Carmina E, Dewailly D, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009; 91:456.
- NIH. Polycystic Ovary Syndrome (PCOS) - Resources. http://prevention.nih.gov/workshops/2012/pcos/resources.aspx (Accessed on March 19, 2013).
- Eilertsen TB, Vanky E, Carlsen SM. Anti-Mullerian hormone in the diagnosis of polycystic ovary syndrome: can morphologic description be replaced? Hum Reprod 2012; 27:2494.
- Ly LP, Handelsman DJ. Empirical estimation of free testosterone from testosterone and sex hormone-binding globulin immunoassays. Eur J Endocrinol 2005; 152:471.
- Sartorius G, Ly LP, Sikaris K, et al. Predictive accuracy and sources of variability in calculated free testosterone estimates. Ann Clin Biochem 2009; 46:137.
- Ly LP, Sartorius G, Hull L, et al. Accuracy of calculated free testosterone formulae in men. Clin Endocrinol (Oxf) 2010; 73:382.
- Pinola P, Piltonen TT, Puurunen J, et al. Androgen Profile Through Life in Women With Polycystic Ovary Syndrome: A Nordic Multicenter Collaboration Study. J Clin Endocrinol Metab 2015; 100:3400.
- Welt CK, Arason G, Gudmundsson JA, et al. Defining constant versus variable phenotypic features of women with polycystic ovary syndrome using different ethnic groups and populations. J Clin Endocrinol Metab 2006; 91:4361.
- O'Reilly MW, Taylor AE, Crabtree NJ, et al. Hyperandrogenemia predicts metabolic phenotype in polycystic ovary syndrome: the utility of serum androstenedione. J Clin Endocrinol Metab 2014; 99:1027.
- Livadas S, Pappas C, Karachalios A, et al. Prevalence and impact of hyperandrogenemia in 1,218 women with polycystic ovary syndrome. Endocrine 2014; 47:631.
- Legro RS, Arslanian SA, Ehrmann DA, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2013; 98:4565.
- New MI. Nonclassic 21-hydroxylase deficiency. Fertil Steril 2006; 86 Suppl 1:S2.
- Derksen J, Nagesser SK, Meinders AE, et al. Identification of virilizing adrenal tumors in hirsute women. N Engl J Med 1994; 331:968.
- Gibson-Helm ME, Lucas IM, Boyle JA, Teede HJ. Women's experiences of polycystic ovary syndrome diagnosis. Fam Pract 2014; 31:545.
- Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed Diagnosis and a Lack of Information Associated With Dissatisfaction in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2017; 102:604.
- American Association of Clinical Endocrinologists Polycystic Ovary Syndrome Writing Committee. American Association of Clinical Endocrinologists Position Statement on Metabolic and Cardiovascular Consequences of Polycystic Ovary Syndrome. Endocr Pract 2005; 11:126.
- Salley KE, Wickham EP, Cheang KI, et al. Glucose intolerance in polycystic ovary syndrome--a position statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007; 92:4546.
- Wild RA, Carmina E, Diamanti-Kandarakis E, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010; 95:2038.
- CLINICAL FEATURES
- Our approach
- - Current diagnostic criteria
- Transvaginal ultrasound
- - Other proposed criteria
- - History and physical
- - Serum androgens
- - Evaluation to exclude other disorders
- Polycystic ovaries on ultrasound
- Features of other endocrine disorders
- Special situations
- - Already taking pharmacologic therapy
- - Severe hyperandrogenism/virilization
- - Delays in diagnosis
- - Diagnosis in postmenopausal women
- FURTHER EVALUATION AFTER DIAGNOSIS
- Cardiometabolic risk assessment
- Role of transvaginal ultrasound
- Nonalcoholic fatty liver disease
- Depression and anxiety disorders
- Anovulatory infertility
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS