What is the best way to diagnose polycystic ovarian syndrome?(CLINICAL INQUIRIES)

EVIDENCE-BASED ANSWER

Polycystic ovarian syndrome (PCOS) is diagnosed for women of childbearing age presenting with 2 of the following: 1) oligo- or anovulatory menstrual irregularities, 2) evidence of hyperandrogenism in the absence of secondary cause; 3) enlarged ovaries with multiple small follicular cysts on transvaginal ultrasound (strength of recommendation [SOR]: C, based on expert opinion).

Depending on the clinical presentation, secondary causes should be excluded (TABLE) (SOR: C, expert opinion). While not among the diagnostic criteria, insulin resistance is common, and patients with PCOS should be evaluated for metabolic abnormalities, particularly hyperlipidemia and glucose intolerance or diabetes (SOR: B, based on prospective cohort studies).

CLINICAL COMMENTARY

Faty liver and insulin resistance are common problems in patients with PCOS

Today we have a better understanding of the relation between obesity, insulin resistance, and polycystic ovarian syndrome (PCOS), but it is not quite clear whether the insulin resistance plays the main pathophysiologic role in this condition. As the prevalence of obesity, metabolic syndrome, and diabetes increases in our society, it is expected that the incidence of PCOS will rise as well.

Unfortunately, there is no single specific diagnostic test available for the diagnosis of PCOS. I practice in a…