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Rotterdam PCOS Criteria

2023ESHRE/ASRM International Guideline — AMH-inclusive

Rotterdam Criteria

2023 update: AMH ≥3.4 ng/mL on a validated assay now qualifies as PCOM in adults. Diagnosis requires exclusion of thyroid dysfunction, hyperprolactinemia, and NCCAH first.

0 of 3 criteria selected

Awaiting Criteria

Select at least one of the three Rotterdam criteria above to see the diagnostic result.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Reproductive-age patient with oligomenorrhea (cycles >35 days) or amenorrhea (>3 missed cycles).

Clinical signs of hyperandrogenism: hirsutism (mFG ≥4–6), acne, androgenetic alopecia.

Biochemical hyperandrogenism: elevated total or free testosterone on a morning fasting sample.

Infertility evaluation for suspected anovulatory cause.

Polycystic ovarian morphology found incidentally on pelvic ultrasound or high AMH in the context of reproductive symptoms.

Screening for metabolic comorbidities in at-risk women (obesity, insulin resistance, family history of T2DM).

Core Diagnostic Rule

PCOS requires ≥2 of 3 Rotterdam criteria PLUS exclusion of other causes. This is not a standalone positive test — differential diagnosis must be completed before applying the label.

Who Should NOT Be Diagnosed by Rotterdam Alone

Adolescents within 2 years of menarche — physiological anovulation is normal; do not use ultrasound criterion at all.

Patients with confirmed non-classic congenital adrenal hyperplasia (NCCAH) — serum 17-OHP must be checked first.

Known hyperprolactinemia — prolactin elevation independently causes oligo-anovulation mimicking PCOS.

Active thyroid dysfunction — TSH must be normal before attributing menstrual irregularity to PCOS.

Androgen-secreting tumor suspected (rapid-onset virilisation, testosterone >150 ng/dL) — requires imaging before PCOS diagnosis.

Postmenopausal women — Rotterdam criteria are not applicable.

Mandatory Exclusionary Workup

TSH	Exclude hypo/hyperthyroidism
Prolactin (fasting)	Exclude hyperprolactinemia; draw before pelvic exam
17-OHP (follicular phase)	Exclude non-classic CAH; >200 ng/dL requires ACTH stim test
Total testosterone	Tumor screen if >150–200 ng/dL or rapidly progressive virilisation
DHEA-S	Adrenal androgen source (elevated in adrenal tumors, mild elevation in PCOS)

Related Scores in Practice

In clinical practice, this assessment is frequently evaluated alongside other validated measures. Depending on the patient's presentation and specific diagnostic requirements, you may also need to utilize the Ferriman-Gallwey Score, HOMA-IR (Insulin Resistance), Ogtt Gdm, Amh Pcos or the Endometrial Thickness to formulate a comprehensive care plan.

Last Comprehensive Review: 2026