Which statement best describes the Rotterdam criteria for diagnosing PCOS?

• A. Hyperandrogenism only.
• B. Ovarian cysts greater than 12 on ultrasound.
• C. Oligo/anovulation plus either clinical/biochemical hyperandrogenism or polycystic-appearing ovaries on ultrasound; other etiologies excluded.
• D. Any two of: obesity, hirsutism, irregular menses.

Answer: (C)

Rotterdam criteria diagnose PCOS when two of three features are present, after ruling out other conditions that could cause similar symptoms. The statement that best fits this is the one that says there is oligo/anovulation plus at least one of the other two features (clinical/biochemical hyperandrogenism or polycystic-appearing ovaries on ultrasound) and explicitly notes exclusion of other etiologies. This captures the two-of-three rule and the need to rule out other causes of androgen excess or ovulatory dysfunction.

Hyperandrogenism by itself isn’t enough, because two features are needed. Relying only on ultrasound-detected ovarian cysts isn’t sufficient either, since many people with polycystic-appearing ovaries don’t have PCOS, and PCOS can be present without a clear ultrasound polycystic morphology depending on criteria used. Obesity, hirsutism, and irregular menses alone do not define the diagnosis; obesity is not a diagnostic criterion, and two features among those listed don’t reliably map to the Rotterdam three-factor framework.