Challenges in the Assessment and Diagnosis of Polycystic Ovary Syndrome.

Abstract

Polycystic ovary syndrome (PCOS)7 is a complex endocrine-mediated disorder in women with a prevalence of 8% to 13%. Women with PCOS typically present with heterogeneous clinical signs and symptoms such as excess hair growth, irregular menstrual cycles, infertility, and metabolic issues. PCOS is associated with cardiometabolic risk factors such as type 2 diabetes, and it may increase risks for other comorbidities like endometrial cancer and nonalcoholic fatty liver disease. PCOS is also associated with anxiety, depression, and other psychosocial manifestations. To date, there are no universal criteria for PCOS diagnosis. As a result, women with the disorder often report significant delays (>2 years) in diagnosis and poor follow-up care. Three sets of diagnostic criteria currently exist to define PCOS: ( a ) NIH, ( b ) Rotterdam, and ( c ) Androgen Excess Society criteria. Recently the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018 endorsed the use of the Rotterdam criteria in adult women. To diagnose PCOS using the Rotterdam criteria, women must meet at least 2 of the following: ovulatory abnormalities, hyperandrogenism (clinical, biochemical, or both), or polycystic ovary morphology (PCOM). The clinician must also exclude several disorders with similar manifestations before a diagnosis can be finalized. In this article, 5 experts discuss the challenges surrounding the current diagnostic criteria, available biomarkers, and the timely diagnosis and treatment of women with PCOS. Who should be screened or tested for PCOS and, despite the high prevalence, why is PCOS often overlooked? Chris McCartney: PCOS should be considered in reproductive-aged women with clinical hyperandrogenism (e.g., hirsutism, acne, male-pattern hair loss), abnormal menstrual bleeding (oligo/amenorrhea, irregular bleeding patterns), or subfertility. Early recognition of PCOS is important for several reasons. For example, accurate attribution of patient symptoms and initiation of appropriate treatments are expected to improve patient well-being. PCOS is also associated …