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Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic Syndrome: An Androgen Excess Society Guideline

Cedars-Sinai Medical Center and The David Geffen School of Medicine at University of California, Los Angeles (R.A.), Los Angeles, California 90048; University of Palermo (E.C.), 90128 Palermo, Italy; Lille University Hospital (D.D.), 59037 Lille, France; University of Athens Medical School (E.D.-K.), GR-157 84 Athens, Greece; Hospital Ramon y Cajal and University of Alcalá (H.F.E.-M.), 28801 Madrid, Spain; Mount Sinai School of Medicine (W.F.), New York, New York 10029; University of Essen (O.E.J.), 45131 Essen, Germany; Pennsylvania State University School of Medicine (R.S.L.), Hershey, Pennsylvania 17033; University of Adelaide (R.J.N.), Woodville, South Australia 5005, Australia; Pfizer Global Research and Development (A.E.T.), Groton, Connecticut 06340; and Children’s Hospital of Pittsburgh (S.F.W.), Pittsburgh, Pennsylvania 15213

Address all correspondence and requests for reprints to: Ricardo Azziz, M.D., M.P.H., M.B.A., Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West Third Street, Suite 160 W, Los Angeles, California 90048. E-mail: azzizr{at}cshs.org.

Objective: The Androgen Excess Society (AES) charged a task force to review all available data and recommend an evidence-based definition for polycystic ovary syndrome (PCOS), whether already in use or not, to guide clinical diagnosis and future research.

Participants: Participants included expert investigators in the field.

Evidence: Based on a systematic review of the published peer-reviewed medical literature, by querying MEDLINE databases, we tried to identify studies evaluating the epidemiology or phenotypic aspects of PCOS.

Consensus Process: The task force drafted the initial report, following a consensus process via electronic communication, which was then reviewed and critiqued by the AES Board of Directors. No section was finalized until all members were satisfied with the contents and minority opinions noted. Statements that were not supported by peer-reviewed evidence were not included.

Conclusions: Based on the available data, it is the view of the AES Task Force on the Phenotype of PCOS that there should be acceptance of the original 1990 National Institutes of Health criteria with some modifications, taking into consideration the concerns expressed in the proceedings of the 2003 Rotterdam conference. A principal conclusion was that PCOS should be first considered a disorder of androgen excess or hyperandrogenism, although a minority considered the possibility that there may be forms of PCOS without overt evidence of hyperandrogenism but recognized that more data are required before validating this supposition. Finally, the task force recognized, and fully expects, that the definition of this syndrome will evolve over time to incorporate new research findings.

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