Polycystic Ovarian Morphology (PCOM) Ultrasound

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Follicle count / volume / age
   Follicle count / ovarian volume / age? (PCOM is one of the Rotterdam two-of-three (hyperandrogenism/ovulatory dysfunction/PCOM or high AMH); those with hyperandrogenism + oligomenorrhea can be diagnosed without ultrasound. Use only >8 years post-menarche (not in adolescents, poor specificity). Report follicle count/ovarian volume, exclude a dominant follicle ≥10 mm/corpus luteum/cyst.)
   • High-frequency probe (≥8 MHz) TVUS: ≥20 follicles per ovary or volume ≥10 mL → Meets PCOM
   • Below the follicle threshold / transabdominal volume ≥10 mL only → Use volume ≥10 mL
   • Adolescent (<8 years post-menarche) → Adolescents: ultrasound not used for diagnosis
2. [End] Meets PCOM
   Meets PCOM (2018/2023 guidelines: high-frequency TVUS ≥20 follicles per ovary, or ovarian volume ≥10 mL): as one Rotterdam criterion; diagnose PCOS combined with hyperandrogenism/ovulatory dysfunction and exclusion of other causes; the 2023 guideline allows AMH above the reference value to substitute for ultrasound in adults.
3. [End] Use volume ≥10 mL
   Below the follicle threshold; with transabdominal or poor images, use ovarian volume ≥10 mL (follicles cannot be reliably counted); if not met it is not PCOM, but PCOS can still be diagnosed by hyperandrogenism + ovulatory dysfunction.
4. [End] Adolescents: ultrasound not used for diagnosis
   Adolescents (<8 years post-menarche): ultrasound/AMH are not used for diagnosis (polycystic morphology is common, poor specificity); requires both hyperandrogenism + ovulatory dysfunction to diagnose, otherwise follow up as at-risk.

Source guidelines & references

• 2023 international evidence-based PCOS assessment and management guideline (J Clin Endocrinol Metab 2023) · source ↗
• PCOM ultrasound criteria (Fertil Steril 2024)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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