The generally accepted Rotterdam criteria for diagnosing PCOS should
include two of the following criteria: chronic anovulation, Hyperandrogenism (HA)
(clinical/biologic), and polycystic ovaries on ultrasound, leading to four types of
clinical presentations. It is a challenge to use the adult reproductive phase criteria for
diagnosing PCOS in the non-reproductive phase of life. Recently, there has been a
consensus on the diagnostic criteria for PCOS in adolescence. In adolescence,
hormonal fluctuations and irregular menstrual cycles can mimic PCOS symptoms,
necessitating careful evaluation to distinguish physiological changes from pathological
ones. Conversely, menopausal transitions can obscure PCOS diagnosis due to
overlapping symptoms such as menstrual irregularities and hormonal imbalances.
Pregnancy introduces additional complexities, as hormonal changes and gestational
conditions may mimic or obscure PCOS symptoms, requiring nuanced diagnostic
approaches. Moreover, PCOS often coexists with other metabolic and reproductive
disorders, such as thyroid dysfunction and endometriosis, further complicating
diagnosis and management. This chapter describes the differential diagnosis strategies
for the accurate identification of PCOS in these intricate scenarios.
Keywords: Adolescents, Diagnosis, Menopause, Pregnancy, PCOS.
