In the Rotterdam 2003 PCOS diagnostic criteria, which two of the following three features are required (plus exclusion of other disorders) for PCOS diagnosis?

• A Polycystic ovarian morphology alone is sufficient for diagnosis without other features
• B Any two of: oligo/anovulation, clinical or biochemical hyperandrogenism, polycystic ovarian morphology on ultrasound ✓
• C All three features must be present simultaneously
• D Elevated LH:FSH ratio > 2:1 is mandatory for diagnosis under Rotterdam criteria

Explanation

The Rotterdam 2003 PCOS consensus requires any two of three features: (1) oligo- or anovulation, (2) clinical or biochemical signs of hyperandrogenism, and (3) polycystic ovarian morphology on ultrasound, after excluding other aetiologies such as congenital adrenal hyperplasia and androgen-secreting tumours. This expanded the original NIH 1990 criteria (which required features 1 and 2 only) to recognise normo-ovulatory and non-hyperandrogenic phenotypes. Elevated LH:FSH ratio is a common finding but is NOT part of the formal diagnostic criteria.

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

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