The ESHRE/ASRM Rotterdam criteria (2003) require at least 2 of 3 features for PCOS diagnosis. A non-obese young woman has oligomenorrhea with cycle length 45 days and multiple follicles (20 follicles in one ovary) on transvaginal ultrasound. Biochemically, LH/FSH ratio is 2.8 but free testosterone and DHEAS are normal. Does she meet Rotterdam criteria?
- A No, biochemical hyperandrogenism is required alongside clinical features
- B Yes, elevated LH/FSH ratio qualifies as biochemical hyperandrogenism
- C Yes, 2 out of 3 criteria met: oligo-anovulation and polycystic ovarian morphology (PCOM) ✓
- D No, a follicle count ≥12 per ovary is needed, not 20
Explanation
She meets 2 Rotterdam criteria: oligo-anovulation (cycle >35 days) and polycystic ovarian morphology on ultrasound (≥20 follicles per ovary by current 2018 ESHRE guidelines, updated from the original ≥12). Biochemical hyperandrogenism (elevated free androgen index, testosterone, or DHEAS) is the third criterion—not required when the other two are present. The LH/FSH ratio is not one of the three Rotterdam criteria and is not part of the diagnostic framework. The Rotterdam consensus includes four phenotypes of PCOS (A: all 3 features; B: HA + oligo-anovulation; C: HA + PCOM; D: oligo-anovulation + PCOM); phenotype D (this patient) is the mildest metabolic risk phenotype.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.