I. Diagnostic criteria for PCOS
(1) Sporadic ovulation or anovulation;
(2) Clinical manifestations of hyperandrogenism and/or hyperandrogenemia;
(3) polycystic ovarian changes: ≥12 follicles of 2-9 mm in diameter in one or both ovaries and/or ovarian volume ≥10 ml;
(4) Two of the above three criteria should be met, and other causes of hyperandrogenism should be excluded: congenital adrenocortical hyperplasia, Cushing’s syndrome, androgen-secreting tumors, and other diseases causing ovulation disorders such as hyperprolactinemia, premature ovarian failure and pituitary or hypothalamic amenorrhea, and thyroid abnormalities.
II. Judgment of the criteria
(1) Sporadic ovulation or anovulation.
1. Judgment criteria: inability to establish regular menstruation 2 to 3 years after menarche; amenorrhea (menopause for more than 3 previous menstrual cycles or ≥ 6 months); sporadic menstruation, i.e., those with cycles ≥ 35 days and ≥ 3 months per year without ovulation (WHO class II anovulation);
2. Regular menstruation cannot be used as evidence of ovulation;
3. Basal body temperature (BBT), ultrasound monitoring of ovulation, and progesterone measurement in the second half of menstruation can help determine whether ovulation is present;
(2) Clinical manifestations of hyperandrogenism: acne and hirsutism
1. Characteristics of hyperandrogenic acne: recurrent acne, often located on the forehead, cheeks, nose and lower jaw;
(2) Features of hyperandrogenic hirsutism: coarse and hard hairs appear on the upper lip, jaw, around the areola, and the midline of the lower abdomen.
(3) Biochemical indicators of hyperandrogenism: total testosterone, free testosterone index [free androgen index (FAI) = total testosterone/SHBG concentration × 100] or free testosterone is higher than the laboratory reference normal value;
(4) PCO diagnostic criteria: ≥12 follicles with 2-9 mm diameter in one or both ovaries and/or ovarian volume ≥10 ml.
【PCO measurement methods】.
1, Vaginal ultrasound is more accurate, transrectal ultrasound is more accurate in patients without sexual history;
2, Early follicular phase (regular menstruation) or without dominant follicle state;
3. Calculation of ovarian volume (ml): 0.5 x length (cm) x width (cm) x thickness (cm);
4, Follicle number measurement should include transverse and longitudinal scans;
5, follicle diameter <10mm, average of transverse and longitudinal diameters.
Third, the exclusion criteria for the diagnosis of PCOS, the exclusion criteria are necessary for the diagnosis of PCOS
(1) If elevated prolactin levels are evident, pituitary tumors should be excluded. 20-35% of patients with PCOS may have mildly elevated prolactin;
(2) If there is sporadic ovulation or anovulation, follicle stimulating hormone (FSH) and estrogen (E2) levels should be measured to exclude premature ovarian failure and central amenorrhea; thyroid function should be measured to exclude sporadic menstruation due to hypothyroidism;
(3) If hyperandrogenemia or obvious clinical manifestations of hyperandrogenism are present, atypical adrenocortical hyperplasia (NCAH) (due to 21-hydroxylase deficiency, measure 17-hydroxyprogesterone level), Cushing’s syndrome, and androgen-secreting ovarian tumors should be excluded.
IV. Comorbidities of PCOS
Polycystic ovary syndrome is often associated with obesity, metabolic syndrome and insulin resistance.
The Association for Androgen Excess Disorders (AES) recommends oral glucose tolerance testing in patients with PCOS (both adults and adolescents) to screen for IGT (impaired glucose tolerance) and DM (diabetes mellitus) ( JCEM, 2007, 92(12):4546-4556). The AES recommendations are as follows.
1, all patients with PCOS, regardless of BMI, should have a 2-hour OGTT to screen for IGT
2, PCOS patients with NGT should be re-screened at least every 2 years, with shorter intervals for those with high-risk factors
3, IGT patients should be monitored annually for progression to DM
4, the main treatment for patients with PCOS and IGT is lifestyle modification and weight loss in obese patients
5, insulin sensitizers, such as metformin and thiazolidinediones, should be used in patients with PCOS and IGT
6, adolescent PCOS patients should repeat the 2-hour OGTT screening IGT every 2 years, if IGT develops, should be actively
Lifestyle modification and treatment with metformin.