Rotterdam Criteria (Need 2 of 3)
| Criterion | Definition | How Assessed |
|---|---|---|
| 1. Oligo/anovulation | Irregular periods (<9 per year) or anovulation | Menstrual history; progesterone day 21 |
| 2. Clinical/biochemical hyperandrogenism | Acne, hirsutism (Ferriman-Gallwey score), male-pattern hair loss; OR raised total/free testosterone | Clinical + free testosterone, SHBG, DHEAS |
| 3. Polycystic ovaries on USS | ≥20 follicles per ovary (2023 consensus) OR ovarian volume ≥10 mL | Pelvic ultrasound |
PCOS Management
| Goal | Intervention |
|---|---|
| Insulin resistance | Weight loss (even 5–10% significantly improves all features); metformin; GLP-1 agonists |
| Irregular periods | Combined oral contraceptive pill — regulates cycle and reduces androgen levels |
| Hirsutism/acne | Anti-androgens (spironolactone, co-cyprindiol); topical treatments; laser hair removal |
| Fertility | Weight loss; clomifene or letrozole (ovulation induction); IVF if above fails |
| Long-term metabolic | Annually: fasting glucose/OGTT, cholesterol, BP monitoring |
GLP-1 Agonists for PCOSSemaglutide and liraglutide promote weight loss and directly improve insulin resistance in PCOS — restoring menstrual regularity and reducing androgen levels. They're increasingly used off-label for PCOS with insulin resistance.
Does everyone with PCOS have cysts?
Confusingly, 'polycystic ovaries' doesn't mean true cysts — they're small follicles that fail to develop and release properly. And having PCO on scan without other features doesn't mean you have PCOS syndrome.
Will PCOS affect my fertility?
PCOS is the most common cause of anovulatory infertility. However, with ovulation induction or IVF, most women with PCOS can conceive. Weight loss significantly improves natural fertility in women with PCOS and overweight.
Does PCOS go away at menopause?
The androgen excess and cysts tend to improve after menopause, but the metabolic features — insulin resistance, diabetes risk, cardiovascular risk — persist and require ongoing monitoring throughout life.
Is metformin the right treatment for PCOS?
Metformin improves insulin sensitivity and can restore menstrual regularity and reduce androgen levels in PCOS — especially in women with confirmed insulin resistance. It's particularly useful when fertility is desired without immediately resorting to IVF.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.