Two Decades After Rotterdam Consensus: A Proposed Novel Evidence-Based Practical Modifications

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy, affecting women, from adolescence to postmenopause. For two decades; PCOS has been defined in reproductive age group by the presence of two of three criteria according to Rotterdam criteria.The aim of this document is to highlight the pitfalls and drawbacks of Rotterdam criteria for diagnosis of PCOS after 20 years of application in clinical practice and to propose a novel evidence-based practical modification of these criteria.

After two decades of Rotterdam consensus, the diagnostic criteria of PCOS could be modified and revised based on evidence-based guidance into three groups: reproductive age, adolescent, and postmenopausal group. The spectrum of PCOS should start from isolated polycystic ovarian morphology, i.e., without hyperandrogenism (HA) and ovulatory dysfunction (OD) to full-blown phenotype (PCOM + HA + OD). Furthermore, each group could be subclassified into obese or lean with presence of IR or not.