Synthetic data only. Never enter patient information; nothing is sent or stored. For clinicians. Not FDA cleared.For licensed clinicians. Educational demonstration on synthetic data. Never enter real patient identifiers or protected health information: everything runs in your browser and nothing is sent or stored. Clinical decision support only; not FDA cleared; physician review is required.
CPE-010 · version 1.0.0
PCOS Pattern Engine: the 2023 criteria, the causes to exclude first, and what to assess next
Two of three criteria in adults, irregular cycles plus hyperandrogenism in adolescents, and PCOS only after other causes are excluded.
PCOS is a diagnosis of exclusion with a moving set of criteria. In adults, the 2023 International Evidence-based Guideline accepts irregular cycles plus hyperandrogenism without ultrasound, and uses ultrasound or AMH only when one of those two is missing. In adolescents it requires both and does not use imaging at all.
The PCOS Pattern Engine applies those rules, refuses to assign PCOS while hyperprolactinemia, thyroid disease, non-classic congenital adrenal hyperplasia, Cushing features or an androgen-secreting tumor are unresolved, and then points to what the guideline asks for next: glycemic status, cardiometabolic risk, endometrial protection in prolonged amenorrhea, sleep, mood and fertility goals.
Playground
Load a synthetic case or type your own values. The result recomputes as you type, and every rule links to its page.
Criteria met (adults need 2 of 3)
✓ 0 of 3
No criterion met
✓ 1 of 3
Not enough
● 2 of 3
Criteria met if causes are excluded
○ 3 of 3
All three present
Cycles and clinical signs
6 or more (4 or more in some ethnicities).
Laboratory and imaging
25 ng/mL is assumed when empty.
Endovaginal ultrasound. Not used in adolescents.
Cardiometabolic, sleep, mood and fertility
What it does
- Counts the three criteria in adults and the two adolescent criteria, and says which ones are met.
- Marks combined hormonal contraception as a limit on interpretation, and refuses to apply the criteria in pregnancy, after menopause or in men.
- Raises hyperprolactinemia, abnormal TSH, a raised 17-hydroxyprogesterone and Cushing features as causes to address before PCOS is assigned.
- Escalates androgen values or features that PCOS does not explain: total testosterone above 150 ng/dL, DHEA-S above 700 µg/dL, rapid virilization.
- Prompts glycemic, cardiometabolic, sleep-apnea and mood assessment, and flags the endometrial risk of prolonged amenorrhea.
What it never does
- Choose contraception, an ovulation-induction agent or any other treatment.
- Use ultrasound in adolescents, or apply the criteria in the first year after menarche.
- Treat acne or alopecia alone as completing the hyperandrogenism criterion.
- Quote prevalence figures such as the share of anovulatory infertility due to PCOS.
Safety gates
These gates run before the pattern is shown, and urgent findings are displayed first.
- Total testosterone above 150 ng/dL, DHEA-S above 700 µg/dL or rapid virilization raises an urgent androgen-tumor alert.
- Prolonged amenorrhea raises a priority endometrial-risk alert.
- A raised prolactin, abnormal TSH or raised 17-hydroxyprogesterone raises an alert to address the cause before PCOS is assigned.
- Combined hormonal contraception raises an interpretation-limit alert.
Inputs
- Cycle history, years since menarche, amenorrhea
- Hirsutism score, acne, alopecia, virilization
- Total testosterone, SHBG, DHEA-S, AMH
- TSH, prolactin, early-follicular 17-hydroxyprogesterone
- Ultrasound findings; BMI, waist, glucose, lipids and blood pressure; contraception and fertility goals
Scope
In scope
- Women of reproductive age
- Adolescents, with adolescent criteria
Routed out
- Men
- Pregnant patients
- Postmenopausal patients
The full rule catalog
22 active rules and 1 sandbox or context entries. Each has its own page with conditions, outputs and evidence. 23 of 23 active rules are exercised by at least one synthetic case.
Scope and validity
Screening
Criteria
Exclusions
Context triggers
Calculations
Missing data
Synthetic cases
Every case is synthetic. Open one to see the inputs, the full result and the rule trace; then change the values.
PCOS-FX-01
Irregular cycles and hirsutism, exclusions complete
A 26-year-old with 8 cycles a year and an mFG of 9.
PCOS-FX-02
Irregular cycles and polycystic ovaries
No hyperandrogenism, 22 follicles per ovary.
PCOS-FX-03
Hyperandrogenism and polycystic ovaries with regular cycles
Ovulatory phenotype.
PCOS-FX-04
Irregular cycles only
One criterion is not enough.
PCOS-FX-05
Criteria met, no exclusion tests
TSH, prolactin and 17-OHP missing.
PCOS-FX-06
Prolactin 68 ng/mL
Another cause of oligomenorrhea.
PCOS-FX-07
TSH 9.2 mIU/L
Thyroid disease explains irregular cycles.
PCOS-FX-08
17-hydroxyprogesterone 340 ng/dL
Non-classic CAH possible.
PCOS-FX-09
Total testosterone 215 ng/dL and rapid virilization
Not explained by PCOS.
PCOS-FX-10
Features of Cushing syndrome
Striae and proximal weakness.
PCOS-FX-11
No period for five months
Prolonged anovulation.
PCOS-FX-12
No glycemic assessment on record
Criteria met.
PCOS-FX-13
Glycemic assessment 40 months ago
Overdue.
PCOS-FX-14
Waist 98 cm, triglycerides 190, HDL 40, BP 134/86
Metabolic syndrome criteria.
PCOS-FX-15
BMI 22
Lean PCOS.
PCOS-FX-16
Mood screening not documented
A prompt.
PCOS-FX-17
Trying to conceive with irregular cycles
Anovulation.
PCOS-FX-18
Normal total testosterone and a low SHBG
A free androgen index of about 7.
PCOS-FX-19
Snoring and BMI 34
Sleep-apnea screening.
PCOS-FX-20
On a combined oral contraceptive
Cycles and androgens are altered.
PCOS-FX-21
Adolescent with irregular cycles and hirsutism
Four years after menarche.
PCOS-FX-22
Adolescent six months after menarche
Too early to apply the criteria.
PCOS-FX-23
Pregnant patient
Outside the pathway.
PCOS-FX-24
A male patient
Outside the pathway.
PCOS-FX-25
Irregular cycles and acne, no work-up yet
A prompt for evaluation.
PCOS-FX-26
No features entered
Nothing to apply.
Evidence
Guidelines and references the rules cite. Each rule page lists the ones that support it.
EV-PCOS-2023Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469.
Supports: Adult diagnosis: irregular cycles plus hyperandrogenism once other causes are excluded; ultrasound or AMH when one is missing Adolescent criteria require both irregular cycles and hyperandrogenism Glycemic, cardiometabolic, sleep and mood assessment; endometrial risk in prolonged anovulation
EV-ROTTERDAM-2004Rotterdam 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;19(1):41-47.
Supports: Two of three criteria: oligo-anovulation, hyperandrogenism, polycystic ovaries, after excluding other disorders
EV-ACOG-PCOS-2018American College of Obstetricians and Gynecologists. Polycystic Ovary Syndrome. ACOG Practice Bulletin No. 194. Obstet Gynecol. 2018;131(6):e157-e171.
Supports: Clinical approach, exclusions and long-term risks
EV-ES-HIRSUTISM-2018Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233-1257.
Supports: Hirsutism assessment (modified Ferriman–Gallwey), biochemical evaluation, and markedly raised androgens or rapid onset as tumor signals
EV-ES-PRL-2011Melmed S, Casanueva FF, Hoffman AR, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011;96(2):273-288.
Supports: Hyperprolactinemia as a cause of oligo-amenorrhea
EV-ES-NCCAH-2018Speiser PW, Arlt W, Auchus RJ, et al. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(11):4043-4088.
Supports: Early-follicular-phase morning 17-hydroxyprogesterone as the screen for non-classic CAH, confirmed by ACTH stimulation
EV-ES-CUSHING-2008Nieman LK, Biller BMK, Findling JW, et al. The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(5):1526-1540.
Supports: Clinical features that prompt testing for Cushing syndrome
Frequently asked questions
Which criteria does the engine use?
The 2023 International Evidence-based Guideline. In adults, irregular cycles plus hyperandrogenism are enough once other causes are excluded; polycystic ovarian morphology or a raised AMH is used when one of those two is missing, giving two of three criteria. In adolescents, both irregular cycles and hyperandrogenism are required and ultrasound is not used.
Why will it not assign PCOS when prolactin is high?
Because PCOS is a diagnosis of exclusion. Hyperprolactinemia, thyroid disease, non-classic congenital adrenal hyperplasia, Cushing syndrome and androgen-secreting tumors can all produce irregular cycles and hyperandrogenism, so the engine asks for those to be addressed first.
Do acne and hair loss count as hyperandrogenism?
Not on their own. Hirsutism (modified Ferriman–Gallwey score of 6 or more) or biochemical hyperandrogenism completes the criterion. Acne and androgenic alopecia are weaker signs that prompt biochemical testing.
What does it do with hormonal contraception?
It marks cycles and testosterone as unreliable while combined hormonal contraception is being taken, and suggests reassessing after about three months off it only if that is acceptable to the physician and patient, or relying on clinical features and history.
Does the engine recommend a treatment?
No. It does not choose contraception, ovulation induction or any other treatment, and it does not name a regimen for endometrial protection. It lists what to assess and which findings need escalation.
Specification status: Executable specification v1.0.0, authored by Biod from the narrative CPE-010 specification and current guidelines. Reviewed by Dr. Vinicius Amaral, D.O. Not for clinical production use.
Clinical review: Dr. Vinicius Amaral, D.O., Medical reviewer, 2026-10-03.
Keep going
CPE-002
Insulin Resistance–Associated Metabolic Pattern Engine
Guideline criteria for glycemia and metabolic syndrome. Insulin resistance itself is never diagnosed from one number.
CPE-001
Thyroid Function Pattern Engine
Functional state from TSH and FT4, kept separate from etiology. Central disease and decompensation never hide.
CPE-004
Iron Deficiency Pattern Engine
Iron status from ferritin and transferrin saturation, read correctly when inflammation, heart failure or kidney disease changes the rules.
Game
Pattern challenge
Guess what the engine will report.
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