Polycystic Ovarian Morphology: Diagnostic Criteria and Prevalence

Lyudmila M. Lazareva, Larisa V. Suturina

International Journal of Biomedicine. 2022;12(1):100-103.
DOI: 10.21103/Article12(1)_RA6
Originally published March 10, 2022


The purpose of this brief review was to systematize the current information on the diagnosis, prevalence, and ethnic aspects of polycystic ovarian morphology (PCOM). The information search was conducted using Internet resources (Medline, Pubmed, Cochrane Library, and Google Scholar) and literature sources for the period from January 1999 to August 2021. The review includes only full-text articles. Based on the analysis of the literature, we demonstrated that the diagnostic value of PCOM has changed since the moment of the first description of polycystic ovarian syndrome (PCOS). Currently, ovarian size, ovarian volume and antral follicle count are key criteria for most PCOS phenotypes and complications. The diagnostic value of PCOM depends on age and racial characteristics, which requires large-scale epidemiological studies to determine PCOM characteristics in different populations. Standardizing PCOM diagnostic criteria is the key to PCOS effective diagnosis and, consequently, to preventing complications and comorbidities associated with PCOS.

PCOM • PCOS • insulin resistance • hyperandrogenism • ultrasound criteria
  1. Kolesnikova LI, Kolesnikov SI, Darenskaya MA, Grebenkina LA, Nikitina OA, Lazareva LM, Suturina LV, Danusevich IN, Druzhinina EB, Semendyaev AA. Activity of LPO Processes in Women with Polycystic Ovarian Syndrome and Infertility. Bull Exp Biol Med. 2017 Jan;162(3):320-322. doi: 10.1007/s10517-017-3605-5. 
  2. Darenskaya MA, Kolesnikov SI, Grebenkina LA, Danusevich IN, Lazareva LM,  Nadelyaeva YaG, et al. [Analysis of pro-and antioxidant activity in the blood of women with different phenotypes of polycystic ovary syndrome and infertility]. Akusherstvo i Ginekologiya. 2017; (8):86–91. doi: 10.18565/aig.2017.8.86-91. [Article in Russian].
  3. Atalyan AV, Kolesnikova LI, Kolesnikov SI, Grzhibovskiy AM, Suturina LV. Research electronic data capture (REDCap) for building and managing databases for population-based biomedical studies. Ekologiya Cheloveka. 2019; (2):52-59.  doi: 10.1016/10.33396/1728-0869-2019-2-52-59. [Article in Russian].
  4. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2018 Sep;89(3):251-268. doi: 10.1111/cen.13795.
  5. Belenkaia LV, Lazareva LM, Walker W, Lizneva DV, Suturina LV. Criteria, phenotypes and prevalence of polycystic ovary syndrome. Minerva Ginecol. 2019 Jun;71(3):211-223. doi: 10.23736/S0026-4784.19.04404-6. 
  6. Lizneva D, Kirubakaran R, Mykhalchenko K, Suturina L, Chernukha G, Diamond MP, Azziz R. Phenotypes and body mass in women with polycystic ovary syndrome identified in referral versus unselected populations: systematic review and meta-analysis. Fertil Steril. 2016 Nov;106(6):1510-1520.e2. doi: 10.1016/j.fertnstert.2016.07.1121. 
  7. Igumnov IA, Sharifulin EM, Belenkaia LV, Lazareva LM, Atalyan AV, Vilson NI, Suturina LV. [Chronic systemic inflammation in pathways of metabolic syndrome associated with hyperandrogenism (review)]. Pathogenesis. 2020; 18(3):12-18. doi: 10.25557/2310-0435.2020.03.12-18. [Article in Russian].
  8. Lesnoy SK. [Partial resection of the ovaries with oligomenorrhea and amenorrhea]. Gynecol Obstetrics. 1928:2:184-191. [Article in Russian].
  9. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004 Jan;19(1):41-7. doi: 10.1093/humrep/deh098.
  10. Carmina E, Azziz R. Diagnosis, phenotype, and prevalence of polycystic ovary syndrome. Fertil Steril. 2006 Jul;86 Suppl 1:S7-8. doi: 10.1016/j.fertnstert.2006.03.012. 
  11. Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018 Aug;132(2):321-336. doi: 10.1097/AOG.0000000000002698.
  12. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF; Androgen Excess Society. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab. 2006 Nov;91(11):4237-45. doi: 10.1210/jc.2006-0178. 
  13. DeUgarte CM, Woods KS, Bartolucci AA, Azziz R. Degree of facial and body terminal hair growth in unselected black and white women: toward a populational definition of hirsutism. J Clin Endocrinol Metab. 2006 Apr;91(4):1345-50. doi: 10.1210/jc.2004-2301. 
  14. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565-92. doi: 10.1210/jc.2013-2350. Epub 2013 Oct 22. Erratum in: J Clin Endocrinol Metab. 2021 May 13;106(6):e2462. 
  15. Rao P, Bhide P. Controversies in the diagnosis of polycystic ovary syndrome. Ther Adv Reprod Health. 2020 Jun 29;14:2633494120913032. doi: 10.1177/2633494120913032. 
  16. Fulghesu AM, Angioni S, Frau E, Belosi C, Apa R, Mioni R, Xamin N, Capobianco GP, Dessole S, Fruzzetti F, Lazzarini V, Minerba L, Melis GB, Lanzone A. Ultrasound in polycystic ovary syndrome--the measuring of ovarian stroma and relationship with circulating androgens: results of a multicentric study. Hum Reprod. 2007 Sep;22(9):2501-8. doi: 10.1093/humrep/dem202. 
  17. Chen X, Yang D, Mo Y, Li L, Chen Y, Huang Y. Prevalence of polycystic ovary syndrome in unselected women from southern China. Eur J Obstet Gynecol Reprod Biol. 2008 Jul;139(1):59-64. doi: 10.1016/j.ejogrb.2007.12.018.
  18. Köşüş N, Köşüş A, Turhan NÖ, Kamalak Z. Do threshold values of ovarian volume and follicle number for diagnosing polycystic ovarian syndrome in Turkish women differ from western countries? Eur J Obstet Gynecol Reprod Biol. 2011 Feb;154(2):177-81. doi: 10.1016/j.ejogrb.2010.10.007. 
  19. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF; Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009 Feb;91(2):456-88. doi: 10.1016/j.fertnstert.2008.06.035.
  20. Hsu MI. Changes in the PCOS phenotype with age. Steroids. 2013 Aug;78(8):761-6. doi: 10.1016/j.steroids.2013.04.005. 
  21. Quinn MM, Kao CN, Ahmad AK, Haisenleder DJ, Santoro N, Eisenberg E, Legro RS, Cedars MI, Huddleston HG; NIH/NICHD Reproductive Medicine Network. Age-stratified thresholds of anti-Müllerian hormone improve prediction of polycystic ovary syndrome over a population-based threshold. Clin Endocrinol (Oxf). 2017 Dec;87(6):733-740. doi: 10.1111/cen.13415. 
  22. Hart R, Doherty DA. The potential implications of a PCOS diagnosis on a woman's long-term health using data linkage. J Clin Endocrinol Metab. 2015 Mar;100(3):911-9. doi: 10.1210/jc.2014-3886. Epub 2014 Dec 22. Erratum in: J Clin Endocrinol Metab. 2015 Jun;100(6):2502.
  23. Han YS, Lee AR, Song HK, Choi JI, Kim JH, Kim MR, Kim MJ. Ovarian Volume in Korean Women with Polycystic Ovary Syndrome and Its Related Factors. J Menopausal Med. 2017 Apr;23(1):25-31. doi: 10.6118/jmm.2017.23.1.25. 
  24. Homburg R. Androgen circle of polycystic ovary syndrome. Hum Reprod. 2009 Jul;24(7):1548-55. doi: 10.1093/humrep/dep049.
  25. Reid SP, Kao CN, Pasch L, Shinkai K, Cedars MI, Huddleston HG. Ovarian morphology is associated with insulin resistance in women with polycystic ovary syndrome: a cross sectional study. Fertil Res Pract. 2017 May 30;3:8. doi: 10.1186/s40738-017-0035-z.
  26. Hong SH, Sung YA, Hong YS, Jeong K, Chung H, Lee H. Polycystic ovary morphology is associated with insulin resistance in women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 2017 Oct;87(4):375-380. doi: 10.1111/cen.13380. 
  27. Adams JM, Taylor AE, Crowley WF Jr, Hall JE. Polycystic ovarian morphology with regular ovulatory cycles: insights into the pathophysiology of polycystic ovarian syndrome. J Clin Endocrinol Metab. 2004 Sep;89(9):4343-50. doi: 10.1210/jc.2003-031600.
  28. Ahmed AA, Moselhy SS, Kumosani TA, Huwait EA, Al-Ghamdi MA, Al-Madani KA, AlToukhi MH, Kumosani AT. Ultrasonographic and biochemical assessments as early prediction of polycystic ovarian syndrome in obese women. Afr Health Sci. 2020 Jun;20(2):676-681. doi: 10.4314/ahs.v20i2.18.

Download Article
Received November 8, 2021.
Accepted December 9, 2021.
©2022 International Medical Research and Development Corporation.