Polycystic ovarian syndrome (PCOS) is a clinical diagnosis characterized by oligo-ovulation, hyperandrogenism, and often the presence of polycystic ovaries.  A common disorder, PCOS affects about 10% of reproductive-age women.¹  Women often present with amenorrhea or oligomenorrhea, hirsutism with acne and male-pattern hair growth, weight gain, and difficulty with fertility. PCOS is associated with an increased risk of developing diabetes mellitus and cardiovascular disease.

Diagnostic criteria for PCOS vary by organization, although all include a component of ovarian disease and the exclusion of alternative diagnoses (refer to Table 1.).  Differential diagnosis includes thyroid disease, hyperprolactinemia, androgen-secreting tumors, adrenal hyperplasia, and Cushing’s syndrome.  Depending on a woman’s presenting symptoms, consider laboratory testing that includes a pregnancy test, TSH (thyroid stimulating hormone), prolactin, total and free testosterone levels, dehydroepiandrosterone (DHEA) sulfate, morning 17a-hydroxyprogesterone, and 24-hour urine cortisol level.  Transvaginal ultrasound may show characteristic changes associated with PCOS, but is not required for the diagnosis if the hormonal features of PCOS are present.

Table 1. Differing Criteria for Polycystic Ovarian Syndrome Among Organizations ²