DIAGNOSIS

Most clinicians use the Rotterdam diagnostic criteria to diagnose PCOS (2003). Two out of the following three features are required:

• Irregular periods (eight or less menstrual bleeds per year)
• Signs of increased androgens in the blood (eg testosterone) or skin and hair (acne/hirsutism/hair loss)
• Polycystic ovarian appearances on ultrasound

The most recent updated PCOS clinical practice guideline supports the use of measurement of antimullerian hormone (AMH) in place of ultrasound in some patients. This is generally only necessary if the patient has just one of either symptoms of androgen excess or irregular periods. Application of the Rotterdam criteria means that there are four categories of patients with PCOS, although the majority of patients are likely to meet all three diagnostic criteria.