Dx of PCOS

• Rotterdam criteria

  2 out of 3 are present & other differentials (androgen-secreting tumor, Cushing's, congenital adrenal hyperplasia) are excluded
• Rotterdam criteria

  • Menstrual irregularity (oligo/amenorrhea) due to ↓ovulation &/ or anovulation
  • Evidence of hyperandrogenism either biochemical or clinical like (hirsutism, acne, frontal balding)
  • Polycystic ovaries on US: > 12 follicles (2-9 mm in diameter in each ovary)
• Free androgen index

  Serum total testosterone/ sex-hormone binding globulin, to detect biochemical hyperandrogenism
• Serum prolactin slightly increased
• LH:FSH Ratio >2
• DHEA-S is elevated in most women with PCOS
• Hyperinsulinaemia can stimulate theca cells to produce more androgens
• Insulin resistance is common in patients with PCOS
• Infertility is the main indication for treatment of PCOS
• The diagnosis of PCOS requires at least two out of three features: oligomenorrhoea/ amenorrhoea, hyperandrogenism, polycystic ovaries
• Letrozole is an aromatase inhibitor which reduces estrogen levels and promotes ovulation