The Rotterdam consensus criteria (2003) for PCOS diagnosis require at least 2 of 3 features. A 24-year-old woman has regular menstrual cycles every 28–30 days, no clinical or biochemical hyperandrogenism, but ultrasound shows 14 follicles of 2–9 mm in the right ovary and 10 in the left (total 24 follicles). Does she meet PCOS criteria?
- A No — she requires at least 2 of the 3 Rotterdam criteria; she has only 1 (PCOM) ✓
- B Yes — polycystic ovarian morphology (PCOM) alone is sufficient for diagnosis
- C Yes — follicle count > 20 automatically confirms PCOS regardless of other features
- D No — Rotterdam criteria require all 3 features to be present
Correct answer: A. No — she requires at least 2 of the 3 Rotterdam criteria; she has only 1 (PCOM)
Explanation
Rotterdam criteria require at least 2 of: (1) oligo/anovulation, (2) clinical/biochemical signs of hyperandrogenism, (3) polycystic ovarian morphology (PCOM) on ultrasound. This patient has regular cycles (no oligo/anovulation) and no hyperandrogenism — she meets only 1 criterion (PCOM). Therefore she does NOT meet Rotterdam diagnostic criteria for PCOS. PCOM alone (even if total follicle count is high) is insufficient. Updated 2023 guidelines define PCOM as ≥ 20 follicles per ovary on ultrasound or ovarian volume ≥ 10 mL.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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