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Diagnostic Criteria in Polycystic Ovary Syndrome (PCOS)

Revised diagnostic criteria of PCOS

1999 criteria (both 1 and 2)

1. Chronic anovulation

2. Clinical and/or biochemical signs of hyperandrogenism, and exclusion of other aetiologies



Revised 2003 criteria (2 out of 3)

1. Oligo- and/or anovulation

2. Clinical and/or biochemical signs of hyperandrogenism

3. Polycystic ovaries

and exclusion of other aetiologies (congenital adrenal hyperplasias, androgen-secreting tumours, Cushing’s syndrome)



Other Proposed Diagnostic Criteria in Polycystic Ovary Syndrome

  1. Inappropriate gonadotropin secretion

a)      Elevated LH-to-FSH ratio

b)      Abnormal response to GnRH agonist testing

2.      Hyperandrogenism

a)      Hirsutism, androgenic alopecia, acne

b)      Hyperandrogenemia

                                                  I.      Total testosterone

                                               II.      Free testosterone (free androgen index, etc.)

3.      Ovarian appearance

a)      Polycystic-appearing ovaries

b)      Increased (stromal) size

4.      Insulin resistance

a)      Acanthosis nigricans

b)      Fasting measures of insulin/glucose

c)      Oral glucose tolerance test

d)      Dynamic tests of insulin sensitivity

                                                  I.      Euglycemic clamp

                                               II.      Frequently sampled intravenous glucose tolerance test

5.      Chronic anovulation

a)      Self-reported history

b)      Tests of ovulatory function

                                                  I.      Basal body temperature charting

                                               II.      Urinary LH testing

                                             III.      Serum progesterone measurement

                                             IV.      Endometrial biopsy


FSH, follicle-stimulating hormone; GnRH, gonadotropin-releasing hormone; LH, luteinizing hormone.

Related Criteria

2001 Bethesda System Terminology

Amsel's Diagnostic Criteria for Bacterial Vaginosis

CDC Diagnostic Criteria for the Diagnosis of Pelvic Inflammatory Disease (PID)

Syndromes or Disease Entities That Have Been Associated with Polycystic Ovaries



  1. The Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004 Jan;19(1):41-7. [Medline]
  2. Legro R. Diagnostic Criteria in Polycystic Ovary Syndrome. Semin Reprod Med. 2003 Aug;21(3):267-75 [Medline]
  3. Reaven G. The metabolic syndrome or the insulin resistance syndrome? Different names, different concepts, and different goals. Endocrinol Metab Clin North Am. 2004 Jun;33(2):283-303. [Medline]

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Created: May 10, 2005
Last Modified: 10/23/2010

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