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CPE-010 · synthetic case PCOS-FX-11
No period for five months
Prolonged anovulation.
Purpose: Prolonged anovulation.
Inputs the engine received
Cycles and clinical signs
- Age
- 30 years
- Years since menarche
- 17 years
- Months without a period
- 5 months
- Hirsutism, modified Ferriman–Gallwey score
- 8
Laboratory and imaging
- TSH
- 1.8 mIU/L
- Prolactin
- 12 ng/mL
- 17-hydroxyprogesterone (early follicular, morning)
- 60 ng/dL
Cardiometabolic, sleep, mood and fertility
- Months since last glycemic assessment
- 6 months
- Depression and anxiety screening done
- Yes
What the engine reports
Prolonged anovulation raises the risk of endometrial hyperplasia. The physician should consider endometrial assessment and protection. The engine names no regimen.
Detected clinical pattern
Pattern Meeting the 2023 PCOS Criteria
Criteria are met and other causes are excluded. A pattern for physician review; the work-up of cardiometabolic risk, sleep, mood and fertility follows.
- Criteria met: 2 of 3 criteria
Why this pattern was identified
- Criteria. 2 of 3 criteria are met (irregular cycles; hyperandrogenism), and other causes have been excluded.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Consider endometrial assessment and protection.
- 2Assess BMI and waist, blood pressure and a lipid profile; the metabolic engine applies the metabolic-syndrome criteria.
Missing information
- Total testosterone with SHBG (high-quality assay).
Evidence and rule trace · 6 rules
PC-02Criterion: irregular cycles
Inputs: amenorrhea 5 months
Irregular cycles / ovulatory dysfunction.
PC-05PCOS criteria met
Inputs: 2 of 3 criteria · exclusions completed
Pattern meeting the 2023 international PCOS criteria.
PC-MISS-01Information needed
Inputs: work-up incomplete
The tests needed to complete criteria and exclusions are not all entered.
PC-11Prolonged amenorrhea
Inputs: amenorrhea 5 months
Prolonged anovulation raises endometrial hyperplasia risk.
Evidence
- EV-PCOS-2023 · Teede 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.
- EV-ROTTERDAM-2004 · 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;19(1):41-47.
- EV-ACOG-PCOS-2018 · American College of Obstetricians and Gynecologists. Polycystic Ovary Syndrome. ACOG Practice Bulletin No. 194. Obstet Gynecol. 2018;131(6):e157-e171.
- EV-ES-HIRSUTISM-2018 · Martin 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.
Physician adjudication required. Clinical decision support for physician review. This output applies published criteria to the values entered. It does not diagnose, exclude other causes by itself, or choose contraception, ovulation induction or any treatment. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
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
More pcos cases
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.
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