The Rotterdam criteria (2003) for PCOS require 2 of 3 features. A woman has oligomenorrhoea and PCO morphology on ultrasound but no clinical or biochemical hyperandrogenism. According to Rotterdam criteria, she:

• A Does NOT meet PCOS criteria — hyperandrogenism is mandatory
• B Has multifollicular ovary, not PCOS
• C Requires LH:FSH ratio >2 to confirm diagnosis
• D Meets PCOS criteria with the non-androgenic phenotype (D) ✓

Explanation

The Rotterdam consensus requires 2 of 3 criteria: (1) oligo/anovulation, (2) clinical/biochemical hyperandrogenism, (3) polycystic ovarian morphology (PCOM) on ultrasound. This patient satisfies criteria 1 and 3, constituting Phenotype D (the non-androgenic phenotype). This phenotype is controversial and carries lower metabolic risk, but is valid under Rotterdam criteria. Hyperandrogenism is NOT mandatory under Rotterdam (though it is mandatory under NIH 1990 criteria).

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

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