PDF herunterladen
Semin Reprod Med 2021; 39(03/04): 071-077
DOI: 10.1055/s-0041-1735259
Review Article

The Need to Reassess the Diagnosis of Polycystic Ovary Syndrome (PCOS): A Review of Diagnostic Recommendations from the International Evidence-Based Guideline for the Assessment and Management of PCOS

Sylvia Kiconco 
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
,
Helena J. Teede
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
2   Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
,
Ricardo Azziz
3   American Society for Reproductive Medicine, Birmingham, Alabama
4   Department of Obstetrics and Gynaecology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
5   Department of Health Policy, Management, and Behaviour; University at Albany School of Public Health, SUNY, Rensselaer, New York
,
Robert J. Norman
6   Department of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, South Australia, Australia
,
Anju E. Joham
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
2   Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
› Institutsangaben
› Weitere Informationen
    Lizenzen und Reprints

Abstract

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that is associated with negative metabolic, reproductive, endocrine, and psychological consequences among women of reproductive age. The diagnosis of PCOS remains challenging due to limited and conflicting evidence regarding definitions for each of the diagnostic features. This review of the recommended PCOS assessment criteria from the international evidence-based guideline highlights the crucial need to reassess, redefine, and optimize the diagnosis of PCOS. Notably, normal values and cut-offs need to be defined for each diagnostic feature across the lifespan and diverse ethnic groups. Understanding how these features cluster together and relate to short- and long-term health outcomes in PCOS is also vital. Ultimately, greater knowledge of the natural history of PCOS is needed through well-characterized, community-based longitudinal studies, which will inform future PCOS diagnosis guidelines and optimize women's health in reproductive life.

Keywords

PCOS - optimal diagnosis - cut-off values - clustering - diagnostic features


Publikationsverlauf

Artikel online veröffentlicht:
17. August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2016; 31 (12) 2841-2855
    CrossrefPubMedGoogle Scholar
  • 2 Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril 2016; 106 (01) 6-15
    CrossrefPubMedGoogle Scholar
  • 3 Azziz R, Carmina E, Dewailly D. et al; Androgen Excess Society. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 2006; 91 (11) 4237-4245
    CrossrefPubMedGoogle Scholar
  • 4 Dokras A, Stener-Victorin E, Yildiz BO. et al. Androgen Excess - Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Steril 2018; 109 (05) 888-899
    CrossrefPubMedGoogle Scholar
  • 5 Azziz R, Marin C, Hoq L, Badamgarav E, Song P. Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metab 2005; 90 (08) 4650-4658
    CrossrefPubMedGoogle Scholar
  • 6 March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010; 25 (02) 544-551
    CrossrefPubMedGoogle Scholar
  • 7 Saini S, Gibson-Helm M, Cooney L, Teede H, Dokras A. Gaps in knowledge in diagnosis and management of polycystic ovary syndrome. Fertil Steril 2016; 106 (03) e100
    CrossrefPubMedGoogle Scholar
  • 8 Dokras A, Saini S, Gibson-Helm M, Schulkin J, Cooney L, Teede H. Gaps in knowledge among physicians regarding diagnostic criteria and management of polycystic ovary syndrome. Fertil Steril 2017; 107 (06) 1380-1386.e1
    CrossrefPubMedGoogle Scholar
  • 9 Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2017; 102 (02) 604-612
    PubMedGoogle Scholar
  • 10 Teede JH, Misso ML, Costello MF. et al. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Monash University. 2018 . Accessed October 27, 2020 at: https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline
    PubMedGoogle Scholar
  • 11 Teede HJ, Misso ML, Costello MF. et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018; 33 (09) 1602-1618
    CrossrefPubMedGoogle Scholar
  • 12 Neven ACH, Laven J, Teede HJ, Boyle JA. A summary on polycystic ovary syndrome: diagnostic criteria, prevalence, clinical manifestations, and management according to the Latest International Guidelines. Semin Reprod Med 2018; 36 (01) 5-12
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 13 Teede HJ, Misso ML, Costello MF. et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 2018; 110 (03) 364-379
    CrossrefPubMedGoogle Scholar
  • 14 Teede HJ, Misso ML, Costello MF. et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clin Endocrinol (Oxf) 2018; 89 (03) 251-268
    CrossrefPubMedGoogle Scholar
  • 15 Tay CT, Hart RJ, Hickey M. et al. Updated adolescent diagnostic criteria for polycystic ovary syndrome: impact on prevalence and longitudinal body mass index trajectories from birth to adulthood. BMC Med 2020; 18 (01) 389
    CrossrefPubMedGoogle Scholar
  • 16 Azziz R. Diagnostic criteria for polycystic ovary syndrome: a reappraisal. Fertil Steril 2005; 83 (05) 1343-1346
    CrossrefPubMedGoogle Scholar
  • 17 Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine F. eds. Polycystic Ovary Syndrome. Boston, MA: Blackwell Scientific; 1992: 377-384
    Google Scholar
  • 18 Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2004; 81 (01) 19-25
    CrossrefPubMedGoogle Scholar
  • 19 Franks S. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: in defense of the Rotterdam criteria. J Clin Endocrinol Metab 2006; 91 (03) 786-789
    CrossrefPubMedGoogle Scholar
  • 20 Lim AJR, Indran IR, Kramer MS, Yong E-L. Phenotypic spectrum of polycystic ovary syndrome and their relationship to the circadian biomarkers, melatonin and cortisol. Endocrinol Diabetes Metab 2019; 2 (03) e00047-e00047
    CrossrefPubMedGoogle Scholar
  • 21 Huddleston HG. Continuum of polycystic ovary syndrome physiology. Fertil Steril 2018; 109 (03) 450-451
    CrossrefPubMedGoogle Scholar
  • 22 Knochenhauer ES, Key TJ, Kahsar-Miller M, Waggoner W, Boots LR, Azziz R. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab 1998; 83 (09) 3078-3082
    PubMedGoogle Scholar
  • 23 Lizneva D, Gavrilova-Jordan L, Walker W, Azziz R. Androgen excess: Investigations and management. Best Pract Res Clin Obstet Gynaecol 2016; 37: 98-118
    CrossrefPubMedGoogle Scholar
  • 24 Harlow SD, Ephross SA. Epidemiology of menstruation and its relevance to women's health. Epidemiol Rev 1995; 17 (02) 265-286
    CrossrefPubMedGoogle Scholar
  • 25 Dumesic DA, Oberfield SE, Stener-Victorin E, Marshall JC, Laven JS, Legro RS. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocr Rev 2015; 36 (05) 487-525
    CrossrefPubMedGoogle Scholar
  • 26 Apter D, Vihko R. Serum pregnenolone, progesterone, 17-hydroxyprogesterone, testosterone and 5 alpha-dihydrotestosterone during female puberty. J Clin Endocrinol Metab 1977; 45 (05) 1039-1048
    CrossrefPubMedGoogle Scholar
  • 27 Peña AS, Doherty DA, Atkinson HC, Hickey M, Norman RJ, Hart R. The majority of irregular menstrual cycles in adolescence are ovulatory: results of a prospective study. Arch Dis Child 2018; 103 (03) 235-239
    CrossrefPubMedGoogle Scholar
  • 28 Broekmans FJ, Knauff EA, Valkenburg O, Laven JS, Eijkemans MJ, Fauser BC. PCOS according to the Rotterdam consensus criteria: change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG 2006; 113 (10) 1210-1217
    CrossrefPubMedGoogle Scholar
  • 29 Livadas S, Diamanti-Kandarakis E. Polycystic ovary syndrome: definitions, phenotypes and diagnostic approach. Front Horm Res 2013; 40: 1-21
    CrossrefPubMedGoogle Scholar
  • 30 McAllister JM, Legro RS, Modi BP, Strauss III JF. Functional genomics of PCOS: from GWAS to molecular mechanisms. Trends Endocrinol Metab 2015; 26 (03) 118-124
    CrossrefPubMedGoogle Scholar
  • 31 Walters KA, Gilchrist RB, Ledger WL, Teede HJ, Handelsman DJ, Campbell RE. New perspectives on the pathogenesis of PCOS: neuroendocrine origins. Trends Endocrinol Metab 2018; 29 (12) 841-852
    CrossrefPubMedGoogle Scholar
  • 32 Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012; 33 (06) 981-1030
    CrossrefPubMedGoogle Scholar
  • 33 Chang WY, Knochenhauer ES, Bartolucci AA, Azziz R. Phenotypic spectrum of polycystic ovary syndrome: clinical and biochemical characterization of the three major clinical subgroups. Fertil Steril 2005; 83 (06) 1717-1723
    CrossrefPubMedGoogle Scholar
  • 34 Wild RA, Vesely S, Beebe L, Whitsett T, Owen W. Ferriman Gallwey self-scoring I: performance assessment in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90 (07) 4112-4114
    CrossrefPubMedGoogle Scholar
  • 35 Yildiz BO, Bolour S, Woods K, Moore A, Azziz R. Visually scoring hirsutism. Hum Reprod Update 2010; 16 (01) 51-64
    CrossrefPubMedGoogle Scholar
  • 36 Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89 (06) 2745-2749
    CrossrefPubMedGoogle Scholar
  • 37 Mani H, Davies MJ, Bodicoat DH. et al. Clinical characteristics of polycystic ovary syndrome: investigating differences in White and South Asian women. Clin Endocrinol (Oxf) 2015; 83 (04) 542-549
    CrossrefPubMedGoogle Scholar
  • 38 Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 1981; 140 (07) 815-830
    CrossrefPubMedGoogle Scholar
  • 39 DeUgarte CM, Woods KS, Bartolucci AA, Azziz R. Degree of facial and body terminal hair growth in unselected black and white women: toward a populational definition of hirsutism. J Clin Endocrinol Metab 2006; 91 (04) 1345-1350
    CrossrefPubMedGoogle Scholar
  • 40 Zhao X, Ni R, Li L. et al. Defining hirsutism in Chinese women: a cross-sectional study. Fertil Steril 2011; 96 (03) 792-796
    CrossrefPubMedGoogle Scholar
  • 41 Azziz R, Kintziger K, Li R. et al. Recommendations for epidemiologic and phenotypic research in polycystic ovary syndrome: an androgen excess and PCOS society resource. Hum Reprod 2019; 34 (11) 2254-2265
    CrossrefPubMedGoogle Scholar
  • 42 Franik G, Bizoń A, Włoch S, Kowalczyk K, Biernacka-Bartnik A, Madej P. Hormonal and metabolic aspects of acne vulgaris in women with polycystic ovary syndrome. Eur Rev Med Pharmacol Sci 2018; 22 (14) 4411-4418
    PubMedGoogle Scholar
  • 43 Uysal G, Sahin Y, Unluhizarci K. et al. Is acne a sign of androgen excess disorder or not?. Eur J Obstet Gynecol Reprod Biol 2017; 211: 21-25
    CrossrefPubMedGoogle Scholar
  • 44 Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol 1977; 97 (03) 247-254
    CrossrefPubMedGoogle Scholar
  • 45 Olsen EA, Messenger AG, Shapiro J. et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol 2005; 52 (02) 301-311
    CrossrefPubMedGoogle Scholar
  • 46 Arlt W. Androgen therapy in women. Eur J Endocrinol 2006; 154 (01) 1-11
    CrossrefPubMedGoogle Scholar
  • 47 Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H. Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. J Clin Endocrinol Metab 2007; 92 (02) 405-413
    CrossrefPubMedGoogle Scholar
  • 48 Ayala C, Steinberger E, Smith KD, Rodriguez-Rigau LJ, Petak SM. Serum testosterone levels and reference ranges in reproductive-age women. Endocr Pract 1999; 5 (06) 322-329
    CrossrefPubMedGoogle Scholar
  • 49 Legro RS, Schlaff WD, Diamond MP. et al; Reproductive Medicine Network. Total testosterone assays in women with polycystic ovary syndrome: precision and correlation with hirsutism. J Clin Endocrinol Metab 2010; 95 (12) 5305-5313
    CrossrefPubMedGoogle Scholar
  • 50 Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 1999; 84 (10) 3666-3672
    CrossrefPubMedGoogle Scholar
  • 51 Ibáñez L, Oberfield SE, Witchel S. et al. An International Consortium Update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence. Horm Res Paediatr 2017; 88 (06) 371-395
    CrossrefPubMedGoogle Scholar
  • 52 Salameh WA, Redor-Goldman MM, Clarke NJ, Reitz RE, Caulfield MP. Validation of a total testosterone assay using high-turbulence liquid chromatography tandem mass spectrometry: total and free testosterone reference ranges. Steroids 2010; 75 (02) 169-175
    CrossrefPubMedGoogle Scholar
  • 53 Salameh WA, Redor-Goldman MM, Clarke NJ, Mathur R, Azziz R, Reitz RE. Specificity and predictive value of circulating testosterone assessed by tandem mass spectrometry for the diagnosis of polycystic ovary syndrome by the National Institutes of Health 1990 criteria. Fertil Steril 2014; 101 (04) 1135-1141.e2
    CrossrefPubMedGoogle Scholar
  • 54 Kumar A, Woods KS, Bartolucci AA, Azziz R. Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf) 2005; 62 (06) 644-649
    CrossrefPubMedGoogle Scholar
  • 55 Spencer JB, Klein M, Kumar A, Azziz R. The age-associated decline of androgens in reproductive age and menopausal Black and White women. J Clin Endocrinol Metab 2007; 92 (12) 4730-4733
    CrossrefPubMedGoogle Scholar
  • 56 Davison SL, Bell R, Donath S, Montalto JG, Davis SR. Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab 2005; 90 (07) 3847-3853
    CrossrefPubMedGoogle Scholar
  • 57 Burger HG, Dudley EC, Cui J, Dennerstein L, Hopper JL. A prospective longitudinal study of serum testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin levels through the menopause transition. J Clin Endocrinol Metab 2000; 85 (08) 2832-2838
    PubMedGoogle Scholar
  • 58 Hansen KR, Knowlton NS, Thyer AC, Charleston JS, Soules MR, Klein NA. A new model of reproductive aging: the decline in ovarian non-growing follicle number from birth to menopause. Hum Reprod 2008; 23 (03) 699-708
    CrossrefPubMedGoogle Scholar
  • 59 Hughesdon PE. Morphology and morphogenesis of the Stein-Leventhal ovary and of so-called “hyperthecosis”. Obstet Gynecol Surv 1982; 37 (02) 59-77
    CrossrefPubMedGoogle Scholar
  • 60 Webber LJ, Stubbs S, Stark J. et al. Formation and early development of follicles in the polycystic ovary. Lancet 2003; 362 (9389(: 1017-1021
    CrossrefPubMedGoogle Scholar
  • 61 Maciel GA, Baracat EC, Benda JA. et al. Stockpiling of transitional and classic primary follicles in ovaries of women with polycystic ovary syndrome. J Clin Endocrinol Metab 2004; 89 (11) 5321-5327
    CrossrefPubMedGoogle Scholar
  • 62 Welt CK, Gudmundsson JA, Arason G. et al. Characterizing discrete subsets of polycystic ovary syndrome as defined by the Rotterdam criteria: the impact of weight on phenotype and metabolic features. J Clin Endocrinol Metab 2006; 91 (12) 4842-4848
    CrossrefPubMedGoogle Scholar
  • 63 Jonard S, Robert Y, Cortet-Rudelli C, Pigny P, Decanter C, Dewailly D. Ultrasound examination of polycystic ovaries: is it worth counting the follicles?. Hum Reprod 2003; 18 (03) 598-603
    CrossrefPubMedGoogle Scholar
  • 64 Carmina E, Lobo RA. Do hyperandrogenic women with normal menses have polycystic ovary syndrome?. Fertil Steril 1999; 71 (02) 319-322
    CrossrefPubMedGoogle Scholar
  • 65 Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet 2007; 370 (9588(: 685-697
    CrossrefPubMedGoogle Scholar
  • 66 Bentzen JG, Forman JL, Johannsen TH, Pinborg A, Larsen EC, Andersen AN. Ovarian antral follicle subclasses and anti-mullerian hormone during normal reproductive aging. J Clin Endocrinol Metab 2013; 98 (04) 1602-1611
    CrossrefPubMedGoogle Scholar
  • 67 Norman RJ. Ovarian size and hormones: speaking volumes about function. Fertil Steril 2020; 113 (02) 337-338
    CrossrefPubMedGoogle Scholar
  • 68 Ahmad AK, Quinn M, Kao CN, Greenwood E, Cedars MI, Huddleston HG. Improved diagnostic performance for the diagnosis of polycystic ovary syndrome using age-stratified criteria. Fertil Steril 2019; 111 (04) 787-793.e2
    CrossrefPubMedGoogle Scholar
  • 69 Rosenfield RL. The polycystic ovary morphology-polycystic ovary syndrome spectrum. J Pediatr Adolesc Gynecol 2015; 28 (06) 412-419
    CrossrefPubMedGoogle Scholar
  • 70 Dewailly D, Gronier H, Poncelet E. et al. Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod 2011; 26 (11) 3123-3129
    CrossrefPubMedGoogle Scholar
  • 71 Pigny P, Jonard S, Robert Y, Dewailly D. Serum anti-Mullerian hormone as a surrogate for antral follicle count for definition of the polycystic ovary syndrome. J Clin Endocrinol Metab 2006; 91 (03) 941-945
    CrossrefPubMedGoogle Scholar
  • 72 Weenen C, Laven JS, Von Bergh AR. et al. Anti-Müllerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol Hum Reprod 2004; 10 (02) 77-83
    CrossrefPubMedGoogle Scholar
  • 73 Cook CL, Siow Y, Brenner AG, Fallat ME. Relationship between serum müllerian-inhibiting substance and other reproductive hormones in untreated women with polycystic ovary syndrome and normal women. Fertil Steril 2002; 77 (01) 141-146
    CrossrefPubMedGoogle Scholar
  • 74 Seifer DB, Maclaughlin DT. Mullerian inhibiting substance is an ovarian growth factor of emerging clinical significance. Fertil Steril 2007; 88 (03) 539-546
    CrossrefPubMedGoogle Scholar
  • 75 Pellatt L, Hanna L, Brincat M. et al. Granulosa cell production of anti-Müllerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab 2007; 92 (01) 240-245
    CrossrefPubMedGoogle Scholar
  • 76 Teede H, Misso M, Tassone EC. et al. Anti-Müllerian hormone in PCOS: a review informing international guidelines. Trends Endocrinol Metab 2019; 30 (07) 467-478
    CrossrefPubMedGoogle Scholar
  • 77 Daniilidis A, Dinas K. Long term health consequences of polycystic ovarian syndrome: a review analysis. Hippokratia 2009; 13 (02) 90-92
    PubMedGoogle Scholar
  • 78 Barry JA, Kuczmierczyk AR, Hardiman PJ. Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2011; 26 (09) 2442-2451
    CrossrefPubMedGoogle Scholar
  • 79 Azziz R, Carmina E, Chen Z. et al. Polycystic ovary syndrome. Nat Rev Dis Primers 2016; 2 (01) 16057
    CrossrefPubMedGoogle Scholar