An International Guideline for the diagnosis and management of polycystic ovary syndrome (PCOS) was released by the International PCOS Network (2018). The International Guideline committees included participants from 37 societies and organizations covering 71 countries. The International Guideline was developed 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, ESHRE and the ASRM. This guideline provides needed definitional criteria to make an accurate diagnosis.
PCOS is a complex disorder characterized by varying degrees of ovulatory dysfunction, hyperandrogenism and metabolic disorders. It carries with it risk of cardiovascular disease and diabetes, as well as endometrial cancer.
The International Guideline Endorses the Rotterdam Criteria
The Rotterdam Criteria requires two out of three of the following
Oligo or amenorrhea
Polycystic ovaries on ultrasound
Ultrasound not necessary for diagnosis when oligo/anovulation and hyperandrogenism present (however, will complete the phenotype)
Both hyperandrogenism and oligo/anovulation must be present
Ultrasound not recommended
History and physical exam findings of
In adolescents, clinical findings must be severe
Reported unwanted excess hair growth and/or alopecia should be considered significant regardless of observed severity
Use one of the following
Free androgen index
Calculated bioavailable testosterone
Consider androstenedione and dehydroepiandrosterone sulfate (DHEAS) if total or free testosterone are not elevated
Note that additional information provided will be limited
Lab tests for hyperandrogenism unreliable for women using hormonal contraception
If lab testing important/required, withdraw hormonal contraception for at least 3 months and use alternate contraceptive during that time
Lab testing for hyperandrogenism most useful when clinical findings unclear or absent
Routine screening for Cushing Syndrome in patients with hyperandrogenic chronic anovulation not indicated – should only occur if patients have coexisting signs
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