Evolution of evidence-based diagnostic criteria in adolescents with polycystic ovary syndrome

Polycystic ovarian syndrome (PCOS) is the most common endocrinopathy in reproductive age women and has significant clinical reproductive, cardiometabolic, dermatological and psychological features (Teede et al., 2010). Diagnostic criteria have evolved historically, resulting in variable global prevalence estimates. The key historical criteria include the 1990 National Institute of Health (NIH) which requires both hyperandrogenism (HA) (clinical and/or biochemical) and ovulatory dysfunction (OD) for diagnosis, without defining these individual criteria (Zawadski and Dunaif, 1992). The 2003 Rotterdam consensus criteria led by the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM), defined PCOS based on at least two out of three of HA, OD, and ultrasound characteristics of polycystic ovarian morphology (PCOM) after exclusion of other causes (Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group, 2004). In 2018, the field advanced considerably with ESHRE, ASRM and 38 other societies and patient groups partnering with the Australian Centre for Research Excellence Monash University, to develop rigorous, evidence-based International Guideline diagnostic criteria, applying best practice evidence synthesis and guideline methods (Teede et al., 2018). Optimizing evidence-based criteria were a key priority in the Guideline to limit under diagnosis or delayed diagnosis and reduce potential over diagnosis based on isolated PCOM features. The International Evidence-based PCOS Guideline built on consensus Rotterdam criteria, refined individual diagnostic components, and differentiated adult and adolescent criteria.