## Rotterdam Criteria for PCOD Diagnosis **Key Point:** The Rotterdam criteria (2003) require **two of three** major features for diagnosis of PCOD. These are: 1. **Oligo- or anovulation** (oligomenorrhea or amenorrhea) 2. **Clinical or biochemical hyperandrogenism** (acne, hirsutism, male-pattern baldness, or elevated androgens) 3. **Polycystic ovarian morphology** on ultrasound (≥12 follicles of 2–9 mm diameter in one ovary, or ovarian volume ≥10 cm³) ### Diagnostic Algorithm ```mermaid flowchart TD A[Suspected PCOD]:::outcome --> B[Exclude other causes]:::action B --> C[Assess for oligomenorrhea/amenorrhea]:::decision B --> D[Assess for hyperandrogenism]:::decision B --> E[Transvaginal ultrasound]:::action C --> F{Feature 1 present?}:::decision D --> G{Feature 2 present?}:::decision E --> H{Feature 3 present?}:::decision F --> I[Count positive features]:::action G --> I H --> I I --> J{≥2 features?}:::decision J -->|Yes| K[PCOD diagnosed]:::outcome J -->|No| L[Consider other diagnoses]:::outcome ``` **High-Yield:** The Rotterdam criteria deliberately include **two of three** (not all three) to capture the heterogeneity of PCOD. A woman with oligomenorrhea and hyperandrogenism but normal ovarian ultrasound can still be diagnosed with PCOD. ### What Must Be Excluded First - Hyperprolactinemia - Thyroid disease (hypo- or hyperthyroidism) - Cushing syndrome - Congenital adrenal hyperplasia (21-hydroxylase deficiency) - Androgen-secreting tumors **Clinical Pearl:** Elevated LH:FSH ratio and hyperinsulinemia are **supportive** findings but are NOT part of the diagnostic criteria. Many PCOD patients have normal LH:FSH ratios.
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.