Table 2.
Diagnostic Strengths and Weaknesses of the Main Features of PCOS as Adapted from the NIH Evidence-Based Methodology Workshop on PCOS
| Diagnostic Criteria | Strength | Limitation |
|---|---|---|
| Hyperandrogenism | Included as a component in all major classifications | Measurement is performed only in blood |
| A major clinical concern for patients | Concentrations differ during time of day | |
| Animal models employing androgen excess resembling but not fully mimicking human disease | Concentrations differ with age Normative data are not clearly defined Assays are not standardized across laboratories Clinical hyperandrogenism is difficult to quantify and may vary by ethnic group, eg, low rates of hirsutism in women with PCOS from east Asia Tissue sensitivity is not assessed |
|
| Ovulatory dysfunction | Included as a component in all major classifications | Normal ovulation is poorly defined |
| A major clinical concern for patients | Normal ovulation varies over a woman's lifetime | |
| Infertility a common clinical complaint | Ovulatory dysfunction is difficult to measure objectively Anovulatory cycles may have bleeding patterns that are interpreted as normal |
|
| PCO morphology | Historically associated with syndrome | Technique dependent |
| May be associated with hypersensitivity to ovarian stimulation | Difficult to obtain standardized measurement Lack of normative standards across the menstrual cycle and lifespan (notably in adolescence) May be present in other disorders that mimic PCOS Technology required to accurately image not universally available Transvaginal imaging possibly inappropriate in certain circumstances (eg, adolescence) or certain cultures |