A 26-year-old woman has documented regular ovulatory cycles confirmed by serial mid-luteal serum progesterone above 30 nmol/L. She has moderate hirsutism, serum testosterone of 75 ng/dL, and transvaginal ultrasound showing 13 follicles of 2 to 9 mm per ovary with ovarian volume of 11 mL. Regarding classification, she:

• A Satisfies neither the Rotterdam nor the NIH criteria for PCOS
• B Satisfies the Rotterdam criteria but not the NIH criteria for PCOS ✓
• C Satisfies both the Rotterdam and the NIH criteria for PCOS
• D Satisfies the NIH criteria but not the Rotterdam criteria for PCOS

Explanation

She fulfills the Rotterdam criteria through hyperandrogenism plus polycystic ovarian morphology, needing only two of three features. The NIH 1990 criteria demand BOTH oligo-ovulation or anovulation AND biochemical or clinical hyperandrogenism, so a strictly ovulatory woman cannot meet them regardless of ultrasound findings. This ovulatory hyperandrogenic phenotype (Rotterdam phenotype B) is precisely why the broader Rotterdam definition captured more women, and it is a favorite discrimination point in examinations.

Reference: Williams Gynecology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.