While the Rotterdam criteria look simple and easy to follow, in clinical practice
diagnosis of PCOS may be problematic because of the use of inaccurate commercial androgen
assays. Progresses in ovarian ultrasound and in AMH measurement have modified the
way to make the diagnosis of PCOS and an update of Rotterdam criteria may be necessary.
In classic severe form of PCOS, ovarian follicle count is a very reliable diagnostic criterion
but AMH measurement may also present high diagnostic specificity and sensitivity. This
finding is particularly important when no clinical signs of androgen excess are present and
only commercial assays for androgen measurement are available.
At the contrary, in mild PCOS phenotypes, sensitivity of AMH measurement is too low
whileFNPO count maintains a high diagnostic sensitivity. However, at least in ovulatory
hyperandrogenic PCOS phenotype, increased AMH values in association with enlarged
ovarian size permit the diagnosis of ovulatory PCOS in 85% of these patients.
Treatment of PCOS women has to be directed to get fertility or in patients not seeking fertility to solve or attenuate
the psychological implications of androgen excess and of irregular menses and the risk of endometrial hyperplasia.
The therapeutic protocols that are used in our department are presented.