PCOS is a complex disorder characterized by varying degrees of ovulatory dysfunction, hyperandrogenism and metabolic disorders. It carries with it the risk of cardiovascular disease and diabetes, as well as endometrial cancer. An International Guideline for the diagnosis and management of polycystic ovary syndrome (PCOS) was released by the International PCOS Network (2023). The guideline was developed with an international advisory panel through the Centre for Research Excellence in Polycystic Ovary Syndrome (CREPCOS), funded by the Australian National Health and Medical Research Council of Australia (NHMRC), in partnership with Monash University, several European societies on reproductive health, and the ASRM. This guideline provides updated definitional criteria to make an accurate diagnosis.
The International Guideline Endorses the Rotterdam Criteria
Note: If hyperandrogenism is present in the setting of irregular menses, ultrasound or AMH are not necessary
Hyperandrogenism
Anovulation
Note: Ovulatory dysfunction can still occur with regular cycles | Confirm anovulation with serum progesterone levels | Nonclassic congenital adrenal hyperplasia (CAH) can mimic PCOS
Ultrasound and Polycystic Ovarian Morphology (PCOM)
Androgens
Note: Lab testing for hyperandrogenism most useful when clinical findings unclear or absent
AMH
Consider Patients at Increased Risk for Metabolic Syndrome
Metabolic Syndrome Implications
Obstructive Sleep Apnea (OSA)
Endometrial Hyperplasia and Cancer Risk
Psychological Features
Pregnancy Risks
Monash University PCOS Program
ACOG Practice Bulletin No 194: Polycystic ovary syndrome
Screening and Diagnosis of Obstructive Sleep Apnea – PcMED Project
CMAJ Review: Diagnosis and management of polycystic ovarian syndrome
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