Parameters:
(1) menstrual and ovulatory changes
(2) hyperandrogenism, clinically and biochemically
(3) appearance of the ovaries on imaging studies
(4) exclusion of other conditions producing increased androgens
(5) features of the metabolic syndrome
Menstrual and ovulatory changes:
(1) irregular menses, amenorrhea, oligomenorrhea, dysfunctional uterine bleeding
(2) anovulatory infertility
Clinical and biochemical hyperandrogenism:
(1) hirsutism
(2) acne
(3) high normal or elevated serum free testosterone
(4) high normal or elevated serum androstenedione
Appearance of the ovaries on imaging studies:
(1) may be normal size or enlarged
(2) typically each ovary shows > 10 cortical cystic follicles, usually < 6 mm in diameter
Exclusion of other conditions associated with increased androgens:
(1) adrenal hyperplasia
(2) adrenal tumors
(3) ovarian tumors
Features of the metabolic syndrome:
(1) central obesity
(2) insulin resistance with hyperinsulinemia
Diagnosis:
• The more features that are present, the more confident the diagnosis.
• While most women manifest ovarian changes, a few women may have normal-appearing ovaries on imaging studies.
