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

Mohammad Emam¹, Reda Hemida¹

¹Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, 35111, Elgomhuria street, Mansoura, Egypt.

Journal of Obstetrics and Gynaecology of India

|May 12, 2025

Summary

Polycystic ovary syndrome (PCOS) diagnosis needs updating after 20 years. This study proposes evidence-based modifications to the Rotterdam criteria for improved clinical practice in women of all ages.

Keywords:

Modifications Pitfalls Polycystic ovary syndrome Rotterdam criteria

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Published on: February 19, 2021

Area of Science:

Reproductive Endocrinology
Gynecology

Background:

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women.
Current diagnosis relies on Rotterdam criteria (2 of 3) for reproductive-aged women.
The Rotterdam criteria have been applied for two decades.

Purpose of the Study:

To identify limitations of the Rotterdam criteria for PCOS diagnosis.
To propose evidence-based modifications for practical application.
To refine PCOS diagnostic criteria for diverse age groups.

Main Methods:

Review of clinical practice and evidence over 20 years.
Analysis of the Rotterdam criteria's diagnostic performance.
Development of revised criteria based on new evidence.

Main Results:

The Rotterdam criteria have limitations after 20 years of use.
A spectrum of PCOS presentation exists, from isolated polycystic ovarian morphology to full phenotype.
Need for age-specific criteria (reproductive, adolescent, postmenopausal) is highlighted.

Conclusions:

The diagnostic criteria for PCOS require revision.
Proposed modifications include age-specific groups and subclassification (obese/lean, with/without insulin resistance).
Revised criteria aim for more accurate and practical PCOS diagnosis across a woman's lifespan.