A 24-year-old with hyperandrogenism, oligomenorrhoea, and polycystic ovarian morphology on ultrasound (right ovary volume 14 mL with 16 follicles 2–9 mm) is diagnosed with PCOS using Rotterdam criteria. Which Rotterdam criterion combination is the minimum requirement for diagnosis?

• A Any 2 of 3 criteria: oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovarian morphology — after exclusion of other aetiologies ✓
• B All three criteria must be present: oligo/anovulation + clinical/biochemical hyperandrogenism + polycystic ovarian morphology
• C Hyperandrogenism must always be present as a mandatory criterion plus one additional criterion
• D Polycystic ovarian morphology alone is sufficient for diagnosis if AMH is elevated

Explanation

Rotterdam 2003 criteria (ESHRE/ASRM consensus) diagnose PCOS when 2 of 3 criteria are present after exclusion of other androgen excess disorders (CAH, Cushing's, androgen-secreting tumours, hyperprolactinaemia, thyroid disease): (1) oligo- or anovulation, (2) clinical and/or biochemical signs of hyperandrogenism, (3) polycystic ovaries on ultrasound (≥ 20 follicles per ovary or ovarian volume > 10 mL on either ovary using modern transducers — updated threshold 2023). Hyperandrogenism is not a mandatory criterion — two women with oligo-anovulation and PCOM without hyperandrogenism still meet Rotterdam criteria. Elevated AMH is supportive but not a diagnostic criterion.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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