Approach to the Patient: Diagnostic Challenges in the Workup for Polycystic Ovary Syndrome

The document addresses the diagnostic challenges of Polycystic Ovary Syndrome (PCOS), a disorder affecting 10% to 13% of women globally. It emphasizes the complexity of diagnosis due to varied phenotypic presentations and the need for a combination of clinical, biochemical, and imaging criteria. The 2023 International PCOS Guideline updates diagnostic criteria, stressing the exclusion of similar disorders and the use of high-quality assays for testosterone. The document highlights the role of anti-Müllerian hormone (AMH) and ultrasound in diagnosis, while noting the need for age- and ethnicity-specific cutoffs. It also discusses the psychological and metabolic comorbidities of PCOS, such as depression and insulin resistance, and underscores the importance of a comprehensive management approach. Six clinical cases illustrate the diagnostic complexities and the necessity for individualized treatment plans.