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 (in some, but not all populations), 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, fatty liver, 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'.)
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- 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