Clinical Health Updates

Clinical rule to diagnose PCOS more accurately

Clinical Question:
What are the key signs and symptoms for the diagnosis of polycystic ovarian syndrome?

Bottom Line:
A simple questionnaire completed by patients before they see the physician can assist in the diagnosis of polycystic ovarian syndrome (PCOS). It is limited by the fact that it has only been validated in a referral setting.

Reference:
Pedersen SD, Brar S, Faris P, Corenblum B. Polycystic ovary syndrome: validated questionnaire for use in diagnosis. Can Fam Physician 2007;53:1041-1047.

Study Design:
Decision rule (validation)

Synopsis:
These authors recruited patients referred to an endocrinology clinic for evaluation. This is a limitation of the study, since these patients have already been filtered by their primary care physicians who made the referral. Patients completed a detailed questionnaire, and then were evaluated by an endocrinologist who was masked to the questionnaire results and who made the final diagnosis of PCOS using standard NIH criteria. Fifty patients had PCOS, 50 did not. The best predictors of PCOS were identified, and the survey was then applied prospectively to a second group of 117 patients, 41 of whom had PCOS using the NIH criteria. The 4 best predictors were: (1) average duration of menstrual cycle greater than 34 days or totally variable; (2) 3 or more sites of dark, coarse hair; (3) obesity between the ages of 16 years and 40 years; and (4) no history of galactorrhea outside of pregnancy or recent childbirth. In the validation cohort, patients with 2 or more factors were likely to have PCOS (positive likelihood ratio = 13), while those with fewer than 2 of these factors were unlikely to have the syndrome (negative likelihood ratio = 0.16).