Rotterdam Criteria - Gynecology

What are the Rotterdam Criteria?

The Rotterdam Criteria are a set of guidelines established in 2003 for the diagnosis of Polycystic Ovary Syndrome (PCOS). According to these criteria, a diagnosis of PCOS can be confirmed if at least two of the following three conditions are present:

Oligo- or anovulation
Clinical and/or biochemical signs of hyperandrogenism
Polycystic ovaries visible on ultrasound

Why were the Rotterdam Criteria established?

The criteria were developed to provide a standardized diagnostic framework, given the heterogeneity of PCOS presentations. Before the establishment of these criteria, there was no consensus on how to diagnose PCOS, leading to inconsistencies in both clinical practice and research.

How are the Rotterdam Criteria different from other diagnostic criteria?

Prior to the Rotterdam Criteria, the most commonly used diagnostic criteria were the National Institutes of Health (NIH) criteria established in 1990. The NIH criteria required the presence of both oligo- or anovulation and hyperandrogenism for a PCOS diagnosis. The Rotterdam Criteria broadened the definition to include polycystic ovaries on ultrasound as an additional diagnostic criterion, thereby recognizing a more diverse spectrum of PCOS manifestations.

What is Oligo- or Anovulation?

Oligo-ovulation refers to infrequent or irregular ovulation, while anovulation is the absence of ovulation. These conditions can lead to irregular menstrual cycles or amenorrhea, and are a common feature of PCOS.

What are the Clinical and Biochemical Signs of Hyperandrogenism?

Clinical signs of hyperandrogenism include hirsutism (excessive hair growth), acne, and androgenic alopecia (male-pattern hair loss). Biochemical signs are elevated levels of androgens such as testosterone. Both types of signs are critical for diagnosing PCOS under the Rotterdam Criteria.

What are Polycystic Ovaries?

Polycystic ovaries are characterized by the presence of 12 or more small follicles (2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume (>10 cm³). These features can be identified through an ultrasound examination.

How Reliable are the Rotterdam Criteria?

While the Rotterdam Criteria have been widely accepted, they are not without controversy. Some experts argue that they may over-diagnose PCOS, particularly in younger women who may naturally have polycystic-appearing ovaries. Nonetheless, the criteria have been validated in numerous studies and remain a cornerstone for PCOS diagnosis.

What are the Implications of a PCOS Diagnosis?

A diagnosis of PCOS has significant implications for a woman's reproductive and metabolic health. Women with PCOS are at increased risk for infertility, type 2 diabetes, cardiovascular disease, and endometrial cancer. Early diagnosis and management are crucial for mitigating these risks.

What are the Management Options for PCOS?

Management strategies for PCOS are tailored to the individual's symptoms and reproductive goals. Options include lifestyle modifications, pharmacological treatments (such as oral contraceptives, anti-androgens, and insulin sensitizers), and fertility treatments if pregnancy is desired. Regular monitoring and a multidisciplinary approach are often recommended.