Diagnosis of Polycystic Ovarian Syndrome: In Defense of the Rotterdam Criteria
Stephen Franks
Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London W12 0NN, United Kingdom
Address all correspondence and requests for reprints to: Dr. Stephen Franks, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London, United Kingdom W12 0NN. E-mail: uks.franks{at}imperial.ac.uk.
Context: Polycystic ovary syndrome (PCOS) is a very common endocrinopathywith a heterogeneous presentation whose etiology is still uncertain.Not surprisingly, therefore, the definition of, and diagnosticcriteria for, PCOS remain controversial.
Objective: The objective of the study was to review and justifythe basis for the recently revised definition of PCOS arisingfrom the joint European Society for Human Reproduction &Embryology/American Society for Reproductive Medicine (ESHRE/ASRM)Rotterdam workshop in 2003.
Intervention(s): The Rotterdam criteria take account of thebroad spectrum of presenting features of PCOS, including womenwith hyperandrogenism but regular menses and, more controversially,those with menstrual disturbance without overt androgen excess.
Positions: The Rotterdam criteria for definition and diagnosisof PCOS, in the opinion of this author, represent a significantadvance in recognizing the broad spectrum of presentation ofthe syndrome and acknowledge that the clinical and biochemicalfeatures may vary with time within individuals. The importantrefinements when compared to the 1990 NIH definition of PCOSare: 1) inclusion of polycystic ovarian morphology; and 2) inclusionof subjects with hirsutism and regular menses.
Conclusions: These new diagnostic criteria for PCOS reflectthe significant advances, particularly from studies of familialPCOS, in understanding of the etiology of the syndrome and thebasis for its heterogeneity. Under the revised diagnostic criteria,the inclusion of women with hyperandrogenism and regular cycleshas met with general agreement. The inclusion of women witholigomenorrhea and polycystic ovaries who do not have clearevidence of androgen excess is, in the opinion of this author,also justified but remains a contentious issue and one thatrequires further investigation.
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