A 26-year-old woman presents with oligomenorrhea since menarche, hirsutism (Ferriman-Gallwey score 16), and acne. Transvaginal ultrasound shows 14 follicles (2-9 mm) per ovary bilaterally. Serum testosterone is elevated and prolactin, TSH, and FSH are normal. According to the Rotterdam 2003 criteria, which statement about her diagnosis is correct?

• A Polycystic ovary syndrome cannot be diagnosed because only two of three Rotterdam criteria are met
• B PCOS is excluded because serum FSH is normal; elevated FSH is required for diagnosis
• C She meets diagnostic criteria for PCOS with oligo-anovulation, clinical and biochemical hyperandrogenism, and polycystic ovarian morphology ✓
• D She has polycystic ovaries on ultrasound only; this is a normal variant and does not constitute a diagnosis of PCOS

Explanation

The Rotterdam 2003 criteria require two of three features: oligo-anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound, after exclusion of other etiologies. This patient has all three. Distractor A is incorrect because only two criteria are required. Distractor D confuses polycystic ovarian morphology with PCOS; the former is an ultrasound finding, the latter is a syndrome requiring clinical or biochemical correlates.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.