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. PCOS can be readily diagnosed when women present with the classic features of hirsutism, irregular menstrual cycles, obesity (in some, but not all, populations), and polycystic ovarian morphology on transvaginal ultrasound (TVUS). 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. The diagnosis of PCOS in adolescents is also reviewed separately. (See "Epidemiology and genetics of the polycystic ovary syndrome in adults" and "Clinical manifestations of polycystic ovary syndrome in adults" and "Treatment of polycystic ovary syndrome in adults" and "Diagnostic evaluation of polycystic ovary syndrome in adolescents".)
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 5 and 12 percent of women, depending upon the population studied (see "Epidemiology and genetics of the polycystic ovary syndrome in adults", section on 'Epidemiology'). 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 one of 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'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CLINICAL FEATURES
- When to suspect PCOS
- - Delays in diagnosis
- History and physical
- Biochemical testing
- - Women with hyperandrogenism
- Normal menstrual cycles
- Already taking pharmacologic therapy
- Severe hyperandrogenism/virilization
- - Women with features of other endocrine disorders
- Transvaginal ultrasound
- Rotterdam criteria (preferred)
- Other proposed criteria
- Postmenopausal women
- DIFFERENTIAL DIAGNOSIS
- Androgen-secreting tumors/ovarian hyperthecosis
- FURTHER EVALUATION AFTER DIAGNOSIS
- Cardiometabolic risk assessment
- - Cardiovascular
- - Sleep apnea
- Role of transvaginal ultrasound
- Nonalcoholic fatty liver disease
- Depression and anxiety disorders
- Anovulatory infertility
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS