ABSTRACT
Part of the difficulty in understanding polycystic ovary syndrome (PCOS) and interpreting
the dense literature surrounding it is that there is no universally accepted clinical
definition. The varying definitions influence the incidence, prevalence of sequelae,
and response to treatment. PCOS is clearly heterogeneous and its etiology is still
speculative. Over the years it has evolved from a "disease" to a "syndrome," the latter
which includes a variety of potential signs and symptoms, including oligo-ovulation,
biochemical or clinical hyperandrogenism, polycystic ovaries, and insulin resistance.
There is no single diagnostic criterion that can be recommended for diagnosis of PCOS.
While hyperandrogenemia, specifically elevated bioavailable testosterone, is intellectually
appealing, the evidence in terms of long-term sequelae identified by such a test is
still weak. The recognition of oligo-ovulation primarily relies on patient history.
Currently both consensus and the preliminary evidence-based trials support a combination
of hyperandrogenemia and oligo-ovulation, in the absence of known causes, as diagnostic
criteria, but there are also strong proponents of using ovarian morphology to identify
and diagnose the syndrome. There are no simple clinically validated biochemical tests
of insulin resistance. Further identification of specific causes, and elimination
of the multiple phenocopies that make up PCOS, will ease its diagnosis.
KEYWORDS
Androgen excess - insulin resistance - ultrasonography - anovulation
