Polycystic ovarian syndrome (PCOS) is a common endocrinopathy typified by oligoovulation or anovulation, signs of androgen excess, and multiple small ovarian cysts. These signs and symptoms may vary widely between women as well as within individuals over time. As a result, women with PCOS may first present to various medical specialists, including gynecologists, internists, endocrinologists, or dermatologists. Thus, a familiarity with PCOS is essential for physicians in each of these specialties.
Polycystic ovarian syndrome is the most common endocrine disorder of reproductive-aged women and affects approximately 4 to 12 percent (Asunción, 2000; Diamanti-Kandarakis, 1999; Farah, 1999; Knochenhauer, 1998). Although symptoms of androgen excess may vary among ethnicities, PCOS appears to equally affect all races and nationalities.
Polycystic Ovarian Syndrome
In 2003 in Rotterdam, The Netherlands, a consensus meeting between the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine (ESHRE/ASRM)—The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2004—redefined PCOS (Table 17-1). Affected individuals must have two of the following three criteria: (1) oligo- and/or anovulation, (2) hyperandrogenism (clinical and/or biochemical), and (3) polycystic ovaries identified sonographically. However, because other etiologies, such as congenital adrenal hyperplasia, androgen-secreting tumors, and hyperprolactinemia, may also lead to oligoovulation and/or androgen excess, these must be excluded. Thus, PCOS is at present a diagnosis of exclusion.
Table 17-1. Definition of Polycystic Ovarian Syndrome |Favorite Table|Download (.pdf)
Table 17-1. Definition of Polycystic Ovarian Syndrome
ESHRE/ASRM (Rotterdam) 2003
To include two out of three of the following:
Oligo- or anovulation
Clinical and/or biochemical signs of hyperandrogenism
Polycystic ovaries (with exclusion of related disorders)
To include both of the following:
Hyperandrogenism and/or hyperandrogenemia (with exclusion of related disorders)
Hyperandrogenism: hirsutism and/or hyperandrogenemia
Ovarian dysfunction: Oligo-anovulation and/or polycystic ovaries
Exclusion of other androgen-excess or related disorders
The Rotterdam criteria constitute a broader spectrum than that formerly put forward by the National Institutes of Health (NIH) Conference in 1990 (Zawadzki, 1990). The latter defined PCOS by ovulatory dysfunction plus clinical hyperandrogenism and/or hyperandrogenemia without regard to ovarian sonographic appearance. Controversy exists as to which definition is more appropriate, and many investigators still use the NIH 1990 criteria as a basis to define PCOS in their population studies (Chang, 2005).
Lastly, a third organization—The Androgen Excess and PCOS Society (AE-PCOS)—has also defined criteria for PCOS (Azziz, 2009). As is shown in Table 17-1, these criteria are similar to those outlined in Rotterdam.
Ovarian Hyperthecosis ...