According to the Rotterdam 2003 criteria, diagnosis of PCOS requires 2 of 3 features. In a 25-year-old woman with regular cycles (28–30 days), clinical hyperandrogenism (hirsutism, acne), and polycystic ovarian morphology on ultrasound (PCOM), the correct diagnosis is:

• A PCOS cannot be diagnosed because cycles are regular (ovulatory)
• B Idiopathic hirsutism; PCOS requires oligomenorrhea as a mandatory criterion
• C PCOS cannot be diagnosed without biochemical hyperandrogenism (elevated total testosterone)
• D PCOS is diagnosed as 2 of 3 Rotterdam criteria are met (hyperandrogenism + PCOM) ✓

Explanation

The Rotterdam 2003 criteria require 2 of 3 features: (1) oligo/anovulation, (2) clinical or biochemical hyperandrogenism, (3) polycystic ovarian morphology on ultrasound. This woman has clinical hyperandrogenism (criterion 2) and PCOM (criterion 3) — 2 of 3 are met, so PCOS is diagnosed even with regular cycles. This is the hyperandrogenic PCOS phenotype D in the ESHRE/ASRM classification. Regular cycles do not exclude PCOS; a subset of PCOS women have regular cycles despite anovulation confirmed biochemically.

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

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