The Rotterdam 2003 PCOS diagnostic criteria require 2 of 3 features. A 26-year-old woman has regular cycles, mild hirsutism (Ferriman-Gallwey score 9), and polycystic ovarian morphology (PCOM) on ultrasound (18 follicles per ovary). Which additional criterion, if absent, would still allow a Rotterdam diagnosis?
- A Oligomenorrhoea or anovulation ✓
- B Elevated LH:FSH ratio >2
- C Biochemical hyperandrogenism (elevated free androgen index)
- D Insulin resistance on oral glucose tolerance test
Explanation
Rotterdam 2003 criteria require 2 of 3: (1) oligo- or anovulation, (2) clinical or biochemical hyperandrogenism, (3) polycystic ovarian morphology on ultrasound. This patient already satisfies criteria (2) (mild hirsutism, clinical hyperandrogenism) and (3) (PCOM with ≥12 follicles per ovary per original 2003 criteria, updated to ≥20 per ovary or ovarian volume >10 mL in ESHRE/ASRM 2018). Therefore, criterion (1) — oligomenorrhoea/anovulation — is not required to satisfy Rotterdam diagnosis; having just 2 features is sufficient. LH:FSH ratio and insulin resistance are not part of diagnostic criteria.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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