The Rotterdam 2003 consensus criteria for PCOS require 2 of 3 features. Which phenotype of PCOS by Rotterdam criteria is associated with the MILDEST metabolic risk?

• A Phenotype A: hyperandrogenism + oligo-anovulation + polycystic ovaries
• B Phenotype D: oligo-anovulation + PCO morphology without hyperandrogenism ✓
• C Phenotype B: hyperandrogenism + oligo-anovulation without PCO morphology
• D Phenotype C: hyperandrogenism + PCO morphology with regular cycles

Explanation

Rotterdam criteria define 4 PCOS phenotypes by combining 3 features. Phenotype D (oligo-anovulation + polycystic ovaries, without hyperandrogenism) is the mildest form with the least metabolic risk — some guidelines debate whether it should be included in PCOS at all. Phenotype A (all three features) carries the highest metabolic risk including insulin resistance, dyslipidaemia, and cardiovascular risk. Phenotype C (ovulatory PCOS) has intermediate risk.

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

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