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Polycystic Ovarian Syndrome
Aya Kamaya, MD, FSRU, FSAR; Priyanka Jha, MBBS
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Polycystic ovarian syndrome (PCOS)
          • Synonyms

            • Stein-Leventhal syndrome
              • Hyperandrogenemia → polycystic ovaries, hirsutism, menstrual abnormalities, obesity
            • Sclerocystic ovary syndrome
          • Definitions

            • Complex heterogenous syndrome of ovulatory dysfunction, menstrual irregularity, and androgen excess
            • Rotterdam criteria for PCOS (2003): 2 of 3 criteria present
              • Ovulatory dysfunction
              • Hyperandrogenism (clinical or biochemical)
              • Polycystic ovarian morphology (PCOM) (by US)
            • PCOM → ovaries meeting criteria on US
              • PCOM: Preferred descriptor when seen on imaging
              • Can be seen in patients with anovulatory PCOS, milder phenotypes of PCOS, and even in women without evidence of metabolic syndrome
              • Isolated PCOM seen in up to 22-30% of normal females and not related to metabolic syndrome
                • Meaning of PCOM in asymptomatic population is currently unknown
                • Can represent mild spectrum of disease

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Gross Pathologic & Surgical Features

                      • Microscopic Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    Selected References

                                    1. Dwivedi AND et al: Colour doppler evaluation of uterine and ovarian blood flow in patients of polycystic ovarian disease and post-treatment changes. Clin Radiol. 75(10):772-9, 2020
                                    2. Expert Panel on Women's Imaging. et al: ACR Appropriateness Criteria® female infertility. J Am Coll Radiol. 17(5S):S113-24, 2020
                                    3. Jarrett BY et al: Ultrasound characterization of disordered antral follicle development in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 105(11), 2020
                                    4. Kostopoulou E et al: Polycystic ovary syndrome in adolescents: pitfalls in diagnosis and management. Curr Obes Rep. 9(3):193-203, 2020
                                    5. Park CH et al: Influence of combined oral contraceptives on polycystic ovarian morphology-related parameters in Korean women with polycystic ovary syndrome. Obstet Gynecol Sci. 63(1):80-6, 2020
                                    6. Peña AS et al: Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC Med. 18(1):72, 2020
                                    7. Azziz R et al: Recommendations for epidemiologic and phenotypic research in polycystic ovary syndrome: an androgen excess and PCOS society resource. Hum Reprod. 34(11):2254-65, 2019
                                    8. Costello MF et al: Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility. Hum Reprod Open. 2019(1):hoy021, 2019
                                    9. Escobar-Morreale HF: Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 14(5):270-84, 2018
                                    10. Dewailly D et al: Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 20(3):334-52, 2014
                                    11. Lujan ME et al: Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod. 28(5):1361-8, 2013
                                    12. Battaglia C et al: Two- and three-dimensional sonographic and color Doppler techniques for diagnosis of polycystic ovary syndrome. The stromal/ovarian volume ratio as a new diagnostic criterion. J Ultrasound Med. 31(7):1015-24, 2012
                                    13. Catteau-Jonard S et al: Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? Ultrasound Obstet Gynecol. 40(2):223-9, 2012
                                    14. Lee TT et al: Polycystic ovarian syndrome: role of imaging in diagnosis. Radiographics. 32(6):1643-57, 2012
                                    15. Rackow BW: Polycystic ovary syndrome in adolescents. Curr Opin Obstet Gynecol. 24(5):281-7, 2012
                                    16. Dewailly D et al: Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod. 26(11):3123-9, 2011
                                    17. Nardo LG et al: Evidence-based approach for the use of ultrasound in the management of polycystic ovary syndrome. Minerva Ginecol. 60(1):83-9, 2008
                                    18. Porter MB: Polycystic ovary syndrome: the controversy of diagnosis by ultrasound. Semin Reprod Med. 26(3):241-51, 2008
                                    19. Mahajan NN et al: Sonographic evaluation of the endometrium in patients with a history or an appearance of polycystic ovarian syndrome. J Ultrasound Med. 26(6):862; author reply 862, 2007
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Polycystic ovarian syndrome (PCOS)
                                            • Synonyms

                                              • Stein-Leventhal syndrome
                                                • Hyperandrogenemia → polycystic ovaries, hirsutism, menstrual abnormalities, obesity
                                              • Sclerocystic ovary syndrome
                                            • Definitions

                                              • Complex heterogenous syndrome of ovulatory dysfunction, menstrual irregularity, and androgen excess
                                              • Rotterdam criteria for PCOS (2003): 2 of 3 criteria present
                                                • Ovulatory dysfunction
                                                • Hyperandrogenism (clinical or biochemical)
                                                • Polycystic ovarian morphology (PCOM) (by US)
                                              • PCOM → ovaries meeting criteria on US
                                                • PCOM: Preferred descriptor when seen on imaging
                                                • Can be seen in patients with anovulatory PCOS, milder phenotypes of PCOS, and even in women without evidence of metabolic syndrome
                                                • Isolated PCOM seen in up to 22-30% of normal females and not related to metabolic syndrome
                                                  • Meaning of PCOM in asymptomatic population is currently unknown
                                                  • Can represent mild spectrum of disease

                                            IMAGING

                                            • General Features

                                              • Ultrasonographic Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Gross Pathologic & Surgical Features

                                                        • Microscopic Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Image Interpretation Pearls

                                                                      Selected References

                                                                      1. Dwivedi AND et al: Colour doppler evaluation of uterine and ovarian blood flow in patients of polycystic ovarian disease and post-treatment changes. Clin Radiol. 75(10):772-9, 2020
                                                                      2. Expert Panel on Women's Imaging. et al: ACR Appropriateness Criteria® female infertility. J Am Coll Radiol. 17(5S):S113-24, 2020
                                                                      3. Jarrett BY et al: Ultrasound characterization of disordered antral follicle development in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 105(11), 2020
                                                                      4. Kostopoulou E et al: Polycystic ovary syndrome in adolescents: pitfalls in diagnosis and management. Curr Obes Rep. 9(3):193-203, 2020
                                                                      5. Park CH et al: Influence of combined oral contraceptives on polycystic ovarian morphology-related parameters in Korean women with polycystic ovary syndrome. Obstet Gynecol Sci. 63(1):80-6, 2020
                                                                      6. Peña AS et al: Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC Med. 18(1):72, 2020
                                                                      7. Azziz R et al: Recommendations for epidemiologic and phenotypic research in polycystic ovary syndrome: an androgen excess and PCOS society resource. Hum Reprod. 34(11):2254-65, 2019
                                                                      8. Costello MF et al: Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility. Hum Reprod Open. 2019(1):hoy021, 2019
                                                                      9. Escobar-Morreale HF: Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 14(5):270-84, 2018
                                                                      10. Dewailly D et al: Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 20(3):334-52, 2014
                                                                      11. Lujan ME et al: Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume. Hum Reprod. 28(5):1361-8, 2013
                                                                      12. Battaglia C et al: Two- and three-dimensional sonographic and color Doppler techniques for diagnosis of polycystic ovary syndrome. The stromal/ovarian volume ratio as a new diagnostic criterion. J Ultrasound Med. 31(7):1015-24, 2012
                                                                      13. Catteau-Jonard S et al: Polycystic ovaries at ultrasound: normal variant or silent polycystic ovary syndrome? Ultrasound Obstet Gynecol. 40(2):223-9, 2012
                                                                      14. Lee TT et al: Polycystic ovarian syndrome: role of imaging in diagnosis. Radiographics. 32(6):1643-57, 2012
                                                                      15. Rackow BW: Polycystic ovary syndrome in adolescents. Curr Opin Obstet Gynecol. 24(5):281-7, 2012
                                                                      16. Dewailly D et al: Diagnosis of polycystic ovary syndrome (PCOS): revisiting the threshold values of follicle count on ultrasound and of the serum AMH level for the definition of polycystic ovaries. Hum Reprod. 26(11):3123-9, 2011
                                                                      17. Nardo LG et al: Evidence-based approach for the use of ultrasound in the management of polycystic ovary syndrome. Minerva Ginecol. 60(1):83-9, 2008
                                                                      18. Porter MB: Polycystic ovary syndrome: the controversy of diagnosis by ultrasound. Semin Reprod Med. 26(3):241-51, 2008
                                                                      19. Mahajan NN et al: Sonographic evaluation of the endometrium in patients with a history or an appearance of polycystic ovarian syndrome. J Ultrasound Med. 26(6):862; author reply 862, 2007