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CPE-010 · synthetic case PCOS-FX-20
On a combined oral contraceptive
Cycles and androgens are altered.
Purpose: Cycles and androgens are altered.
Inputs the engine received
Cycles and clinical signs
- Age
- 25 years
- Years since menarche
- 12 years
- Cycles per year
- 10
- Hirsutism, modified Ferriman–Gallwey score
- 7
- Combined hormonal contraception now or in the last 3 months
- Yes
Laboratory and imaging
- TSH
- 2 mIU/L
- Prolactin
- 11 ng/mL
- 17-hydroxyprogesterone (early follicular, morning)
- 60 ng/dL
What the engine reports
Cycles and testosterone are altered, so PCOS cannot be reliably assessed on them. If the risks are acceptable, reassess after contraception is stopped for about 3 months; otherwise rely on clinical features and history. That decision belongs to the physician and patient.
Detected clinical pattern
Assessment Limited by Hormonal Contraception
Cycles and testosterone are altered by contraception, so criteria cannot be reliably applied.
- Criteria met: 1 of 3 criteria
Missing information
- Total testosterone with SHBG (high-quality assay).
Evidence and rule trace · 3 rules
PC-VAL-01Hormonal contraception limits interpretation
Inputs: combined hormonal contraception now or in the last 3 months
Cycles and androgens are altered; PCOS cannot be reliably assessed on them.
PC-MISS-01Information needed
Inputs: work-up incomplete
The tests needed to complete criteria and exclusions are not all entered.
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-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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