Given the wide variety of PCOS symptoms, professional organizations have attempted to unify diagnosing criteria for PCOS in recent years. Currently, the most widely utilized criteria are the so-called Revised Rotterdam Criteria, on which the two major professional organizations in the field, ASRM and ESHRE, have agreed: Under Revised Rotterdam Criteria, a patient demonstrating at least two out of the following three criteria is diagnosed with PCOS: (1) Oligo-amenorrhea or amenorrhea; (2) hyperandrogenism (high androgens, diagnosed either by clinical symptoms or by laboratory testing): and (3) evidence of an ovarian PCO phenotype by imaging (ultrasound).
PCOS is not ONE condition - it is really a whole group of different conditions.
These criteria have, however, remained somewhat controversial, not the least because according to the criteria a woman can theoretically be diagnosed with PCOS without ultrasound evidence that she has PCO.
Increasingly, PCOS diagnosis is made by anti-Müllerian hormone (AMH) levels. Excessively high AMH levels characterize PCOS, though absolute cut-off levels have not been established. The likely reason is that AMH levels decline with advancing female age, and what represents excessively high levels varies with age (for further information on age-specific hormone levels, please refer to our anti-Mullerian hormone page). Clinical manifestations of PCOS also decline with advancing age.
Clinical characteristics of PCOS can differ greatly. For example, a widely held misconception of PCOS, even amongst physicians, is that every woman with PCOS is relatively short and obese with signs of excess male hormones (hyperandrogenism) and virilization, such as oily skin, acne, excessive facial hair, etc. In reality, only approximately 40% of women with PCOS have this kind of peripheral phenotype (appearance). Women with PCOS can also be six feet tall, model-skinny, with absolutely no sign of high levels of androgens (male hormones).
One of the most common endocrine problems in women, PCOS is now recognized not only as a hormonal problem resulting in PCOS-related infertility. Especially (though not exclusively) its hyperandrogenic form is also associated with the so-called metabolic syndrome, a combination of risk factors for arteriosclerotic heart disease and diabetes mellitus. Timely and correct diagnosis of PCOS, and its specific phenotypes, therefore, has importance not only for fertility but also for the overall health of patients.
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Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.