Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility, 81(1), 19-25. https://doi.org/10.1016/j.fertnstert.2003.10.004
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19-25. doi:10.1016/j.fertnstert.2003.10.004
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. "Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome." Fertility and Sterility, vol. 81, no. 1, 2004, pp. 19-25.
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RRM Academy Synopsis
Rotterdam workshop defines PCOS by two of three features
A 2003 expert workshop defined PCOS by two of three features, once other causes are ruled out. The Rotterdam group also linked PCOS to a higher type 2 diabetes risk and called the heart disease risk uncertain.
Key Findings
The 2003 criteria call for 2 out of 3 features: oligo- or anovulation, signs of hyperandrogenism, and polycystic ovaries, after other causes are excluded. The 1990 criteria required chronic anovulation plus hyperandrogenism.
The group said tests of insulin resistance are unnecessary for diagnosing PCOS or choosing treatment. For obese women with PCOS it advised a metabolic syndrome check with an oral glucose tolerance test.
Type 2 diabetes risk was increased (3–7 times) in women with PCOS. The risk is greater with anovulation and polycystic ovaries, with obesity, and when type 2 diabetes runs in the family.
Approximately 60% of women with PCOS have elevated LH concentrations. The group judged serum LH unnecessary for the clinical diagnosis.
Cardiovascular disease risk is uncertain at present. Limited epidemiological data showed no increase in cardiovascular events, and the cohorts studied were young (around 55 years).
Interpretation
This is a 2003 consensus statement from an ESHRE- and ASRM-sponsored workshop held in Rotterdam, built on a review of the existing literature. The group described PCOS as a heterogeneous disorder where a rigid definition may hamper understanding. The authors noted that no firm conclusions could yet be drawn on long-term cardiovascular risk and called for follow-up of PCOS cohorts into their sixties and beyond.
RRM Context
Restorative reproductive medicine begins with diagnosis. The group calls PCOS a diagnosis of exclusion, so mimicking disorders come first. The group also noted that androgen levels fall faster than other features under hormonal suppression. Levels may stay low after stopping. The ultrasound definition does not apply to women on the oral contraceptive pill (a suppressive medication). Polyendocrine metabolic ovarian syndrome (PMOS) is the newer name for PCOS. This 2003 statement uses PCOS.
Our editorial summary of this paper, not the article's abstract.
Abstract
Since the 1990 National Institutes of Health-sponsored conference on polycystic ovary syndrome (PCOS), it has become appreciated that the syndrome encompasses a broader spectrum of signs and symptoms of ovarian dysfunction than those defined by the original diagnostic criteria. The 2003 Rotterdam consensus workshop concluded that PCOS is a syndrome of ovarian dysfunction along with the cardinal features hyperandrogenism and polycystic ovary (PCO) morphology. PCOS remains a syndrome, and as such no single diagnostic criterion (such as hyperandrogenism or PCO) is sufficient for clinical diagnosis. Its clinical manifestations may include menstrual irregularities, signs of androgen excess, and obesity. Insulin resistance and elevated serum LH levels are also common features in PCOS. PCOS is associated with an increased risk of type 2 diabetes and cardiovascular events.
PMOS / PCOS has four diagnostic phenotypes and distinct metabolic, reproductive, and mental health implications. How RRM-trained clinicians approach diagnosis and treatment differently.
