Rotterdam 2003 criteria for PCOS require 2 of 3 features. A 22-year-old woman has polycystic ovarian morphology on ultrasound (≥20 follicles per ovary on 2D ultrasound) and elevated testosterone but regular menstrual cycles. Does she fulfill Rotterdam criteria for PCOS?

• A No, because she needs all three criteria
• B No, because oligo/anovulation is mandatory
• C Yes, polycystic morphology plus biochemical hyperandrogenism fulfills 2 of 3 criteria ✓
• D Yes, but only if LH:FSH ratio is above 2

Explanation

Rotterdam 2003 criteria diagnose PCOS when 2 of the following 3 features are present: (1) oligo- or anovulation, (2) clinical or biochemical signs of hyperandrogenism, (3) polycystic ovarian morphology on ultrasound (≥12 follicles 2–9 mm in 2003 criteria, updated to ≥20 per ovary in 2018 update using high-frequency transducers). This patient has polycystic morphology (criterion 3) and biochemical hyperandrogenism (criterion 2), fulfilling 2 of 3 — Rotterdam PCOS diagnosis is valid even without irregular cycles.

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

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