KatCarney

Diagnostic Criteria Refined And Risks Spelled Out For Polycystic Ovary Syndrome

Fifteen years after the first international conference on polycystic ovary syndrome (PCOS) was sponsored by NIH, members of the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine held a consensus workshop to more exactly characterize the syndrome.

As a syndrome of ovarian dysfunction, PCOS does not have a single criterion for diagnosis. It is a complex of different conditions that are found in combination. But because PCOS encompasses such a broad spectrum of signs and symptoms, diagnosis can be frustratingly difficult. In an attempt to simplify matters, the doctors meeting in Rotterdam revised diagnostic criteria. To be diagnosed with PCOS, a patient must exhibit two of the three following conditions: irregular or absent ovulation, elevated levels of androgenic (male) hormones, and/or enlarged ovaries containing 12 or more follicles each.

The group emphasized that an important part of making a diagnosis of PCOS must be ruling out other conditions, like androgen-secreting tumors or Cushing’s syndrome, that can present the same symptoms. And if a woman has polycystic ovaries, but normal ovarian function, and exhibits no signs of elevated androgen hormones, she should not be considered as having PCOS until more is known about her condition.

Polycystic ovary syndrome is associated with insulin resistance and increased risk of type 2 diabetes, especially if there is a family history of the disease or if the patient is obese. Because tests for insulin resistance are inexact, the group recommended that PCOS patients be evaluated for metabolic syndrome. This involves measuring for abdominal obesity, triglycerides, high-density lipoproteins, high blood pressure, and fasting and two hour glucose tolerance. In addition, there is some evidence that women with PCOS are at increased risk for cardiovascular disease and it is thought that they may also be at increased risk for endometrial cancer.

Robert Schenken, MD, President-Elect of ASRM, remarked “PCOS remains a syndrome and no constellation of findings or set criteria can exclusively be used for a clinical diagnosis or for inclusion in clinical research. Further studies are needed to assess risk levels based on different diagnostic criteria.”

Robert Rebar, MD, Executive Director of ASRM, added, “This is by no means a final definition of the syndrome. While the clarification of diagnostic criteria might improve the ability of clinicians and researchers to discuss PCOS, the way the criteria are framed- as two out of three required for diagnosis- may cause some confusion. And I agree with Dr. Schenken that more research is needed to clarify the way the risks of PCOS relate to the individual patient’s manifestation of the syndrome.”

(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, Fertility and Sterility, Vol.81, No.1, January 2004)

Source: http://www.asrm.org/Washington/Bulletins/vol6no05.html

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