The revised Rotterdam 2023 International Evidence-Based Guidelines for PCOS diagnosis require which minimum criterion combination in adults?

• A Two of three: oligo-anovulation, clinical/biochemical hyperandrogenism, polycystic ovarian morphology (PCOM)
• B Hyperandrogenism (clinical or biochemical) PLUS at least one of: irregular cycles or PCOM ✓
• C Three of four: oligo-anovulation, hyperandrogenism, PCOM, and insulin resistance
• D Oligo-anovulation plus PCOM on ultrasound plus LH:FSH ratio >2 in the follicular phase

Explanation

The 2023 International Evidence-Based Guideline (Teede et al., 2023) updated PCOS diagnosis: in adults, the diagnosis requires hyperandrogenism (clinical — Ferriman-Gallwey score ≥4–6 depending on ethnicity, or biochemical — elevated free testosterone or DHEA-S) PLUS at least one of: irregular menstrual cycles OR polycystic ovarian morphology (PCOM — follicle number per ovary ≥20 on high-frequency ultrasound, or ovarian volume ≥10 mL). This change makes hyperandrogenism a mandatory criterion rather than optional, reflecting evidence that it is the most clinically significant feature. The original Rotterdam 2003 criteria (A) allowed two of any three, but the 2023 revision mandates hyperandrogenism. Options C and D are incorrect — LH:FSH ratio (D) is not a diagnostic criterion in any current guideline.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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