According to the Rotterdam criteria, PCOS is diagnosed based on which combination?

• A. Hyperandrogenism, ovulatory dysfunction, and polycystic ovaries; at least two of three criteria after excluding other causes.
• B. Obesity, acne, irregular menses.
• C. Hyperprolactinemia, thyroid dysfunction, ovarian cysts.
• D. Infertility alone defines PCOS.

Answer: (A)

Rotterdam criteria diagnose PCOS when at least two of three features are present, after excluding other conditions that can mimic PCOS. The three features are hyperandrogenism (clinical signs like hirsutism or acne, or elevated androgens), ovulatory dysfunction (irregular or absent ovulation with oligomenorrhea or amenorrhea), and polycystic ovaries on ultrasound (multiple small follicles or increased ovarian volume). The key point is that you don’t need all three—any two of the three suffice, and other causes must be ruled out to avoid misdiagnosis. This means a patient can have hyperandrogenism with ovulatory dysfunction even if ultrasound does not show polycystic ovaries, or other combinations as long as two criteria are met. Options that rely on non-specific signs like obesity or acne alone, or on infertility alone, don’t meet the diagnostic standard. Also, conditions such as thyroid disease, hyperprolactinemia, Cushing’s syndrome, or androgen-secreting tumors should be excluded before confirming PCOS.