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This version published online on January 17, 2006
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-2153
A more recent version of this article appeared on March 1, 2006
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Submitted on September 29, 2005
Accepted on December 23, 2005

THE ROTTERDAM 2003 CRITERIA FOR DEFINING PCOS: CON (OR HOW TO DEFINE A SYNDROME)

Ricardo Azziz MD, MBA, MPH*

Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, and Depts. of Medicine, and Obstetrics and Gynecology, the David Geffen School of Medicine at UCLA, Los Angeles, California

* To whom correspondence should be addressed. E-mail: azzizr{at}cshs.org.

Context: Polycystic ovary syndrome (PCOS) is defined most commonly according to the proceedings of an expert conference sponsored by the National Institutes of Health (NIH) in April 1990, which noted the disorder as having: i) hyperandrogenism and/or hyperandrogenemia, ii) oligo-ovulation, and iii) exclusion of known disorders. Alternatively, another expert conference held in Rotterdam in May 2003 defined PCOS, after the exclusion of related disorders, by two of the following three features: i) oligo- or anovulation, ii) clinical and/or biochemical signs of hyperandrogenism, or iii) polycystic ovaries. In essence, the Rotterdam 2003 expanded the NIH 1990 definition creating two new phenotypes: a) ovulatory women with polycystic ovaries and hyperandrogenism, and b) oligo-anovulatory women with polycystic ovaries, but without hyperandrogenism.

Objective: To ascertain the validity of using the Rotterdam 2003 criteria rather than the NIH 1991 criteria for diagnosis PCOS.

Case: Not applicable.

Intervention(s): The use of the Rotterdam 2003 criteria for diagnosing PCOS, and in particular the proposal to define two new phenotypes as having PCOS.

Positions: Available data suggest that hyperandrogenic ovulatory women with polycystic ovaries tend to have mild insulin resistance and mild evidence of ovarian dysfunction, although significantly less than women with anovulatory PCOS. However, whether these women will have an increased risk of infertility or metabolic complications, such as type 2 diabetes, remains to be determined. The risk of insulin resistance and long-term metabolic risks of oligo-ovulatory women with polycystic ovaries is even less well characterized.

Conclusions: Because of the paucity of data on the two new phenotypes and their long-term implications, and the potential negative impact on research, clinical practice and patient insurability, the adoption of the Rotterdam 2003 criteria for defining PCOS should be considered premature. However, as polycystic ovaries are a frequent feature of PCOS, a modification of the NIH 1990 criteria is proposed. Further research characterizing the phenotypes and associated morbidities of PCOS is urgently required.
Key words: Polycystic ovary syndrome • hirsutism • criteria




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