I've been on this forum for decades and I'm increasingly uneasy about how we approach PCOS. Every few years, it seems like the criteria—and often the entire diagnostic framework—gets overhauled, making it feel like we're chasing a moving target. Despite countless studies, we're still largely relying on ultrasound findings and hormone assays that can vary wildly between labs, and then using those figures to label a diverse group of women with the same syndrome.
Is it time to admit that PCOS, as we're diagnosing it today, might be more of a convenient catch-all than a clearly defined condition? We’ve seen the rise and fall of the Rotterdam criteria, the NIH guidelines, and some newer proposals, all of which seem to serve the moment rather than reflect a solid understanding of the underlying biology.
Moreover, the current treatment algorithms tend to focus heavily on pharmaceutical interventions, even though many patients might benefit more from personalized lifestyle modifications. It often feels like the narrative is driven by economic incentives rather than patient-centered outcomes.
So I'm asking: Is there really scientific consensus behind our current diagnostic methods, or are we clinging to outdated and overly simplistic models? How can we develop a more robust, individualized approach that reflects the true complexity of what we call PCOS? I’m keen to hear from both clinicians and long-time patients—what are we missing here, and how do we break free from this cycle of over-diagnosis and one-size-fits-all treatment?