Clinical inquiries. What is the best way to diagnose polycystic ovarian syndrome?

n Evidence summary Polycystic ovarian syndrome is a condition of unexplained hyperandrogenic chronic anovulation that affects at least 4% of women of reproductive age. Because PCOS is a clinical syndrome, no single diagnostic criterion is sufficient for diagnosis. Clinical features include menstrual irregularities or infertility, hirsutism, male-pattern balding, acne, ovarian enlargement, and signs of insulin resistance (eg, central obesity, acanthosis nigricans). A 2003 international consensus panel concluded that the presence of 2 of 3 criteria (oligo/anovulation, hyperandrogenism, polycystic ovaries), in the absence of other secondary causes, is sufficient to make the diagnosis. Evidence for hyperandrogenism includes hirsutism, acne, or elevated total testosterone levels. A high luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio supports the C L I N I C A L C O M M E N T A R Y