Diagnosing PCOS and PCOM


30 Sep Diagnosing PCOS and PCOM

Polycystic ovary syndrome (PCOS) is the

most common endocrine disorder in women

of reproductive age and affects between 10%

and 21% of women depending on the diag

nostic criteria used and population assessed.

The condition has many short-term and

long-term complications, including repro

ductive (such as, amenorrhoea, anovulation,

hirsutism, infertility and pregnancy compli

cations), metabolic (diabetes mellitus, dys

lipidaemia and cardiovascular risk factors)

and psychological (depression, anxiety, body

image and quality of life) disorders.

In clinical practice, PCOS is under
recognised, diagnosis is often delayed and
women report unsatisfactory diagnosis expe
rience and inadequate education.
A key contributor to these issues is the controversy over
diagnostic criteria. The Rotterdam consensus
from 2003) defines PCOS as two of three
criteria: oligo-ovulation or anovulation;
polycystic ovarian morphology (PCOM)
on ultrasonography; and hyperandrogen
ism with the exclusion of other aetiologies.
Under the Rotterdam criteria, four diagnostic
reproductive phenotypes are included,
phenotypes C and D are new
additions to the definition. The Rotterdam
criteria are now internationally accepted,
and the focus of research has moved to
refining each of the individual diagnostic
features. However, as each feature of PCOS
represents a continuum, diagnostic thresh
olds are arbitrary and women with PCOS
cannot be clearly differentiated from the
normal population. Given these considerations,
concerns of over diagnosis have also been raised.

PCOM is perhaps the most controversial

of the PCOS diagnostic criteria and is based

on the unilateral or bilateral presence of >12

follicles with a diameter of 2–9 mm and/or an

ovarian volume >10 ml. However, as

ultrasonography technology has advanced,

follicles are more easily detected than with

previous equipment, and the prevalence of

PCOM in the population is now between

20% in adults and 84% in adolescents with

current PCOM criteria, including many

without PCOS. Consequently, the Androgen

Excess and PCOS Society (AE–PCOS) task

force reviewed the evidence and published

recommendations in 2014 that aimed to

refine PCOM criteria and improve the accu-

racy of diagnosis of PCOS.

The task force recommended that PCOM

be defined as >25 follicles per ovary with

a diameter between 2 mm and 10 mm.

However, this definition was contingent on

the use of new ultrasonography technology

(with a transducer frequency >8 MHz). The

task force recognized that this technology is

not always available and ovarian volume of

>10 ml could be substituted as an alternative

for PCOM, which recognizes the limitations

in specificity and sensitivity compared with

follicle number per ovary. 

However, no investigators have reported on the 

adoption of these AE–PCOS recommendations

or described their practicality in clinical

care. Interestingly, the AE–PCOS task force

also reports that women with ‘mild’ PCOS

(hyperandrogenism plus PCOM (pheno

type C) or oligo-ovulation or anovulation

plus PCOM (phenotype D)) would probably

have similar management and, therefore,

ultra sonography might not impact on clin

ical care. Given these considerations and

the persisting need to still disseminate

and implement the AE–PCOS recommenda

tions, their clinical relevance and impact are

difficult to judge.

PCOS phenotype chart

phenotype of PCOS

Source: Nature

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