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Pathways to Prevention (P2P) Program

Evidence-based Methodology Workshop on Polycystic Ovary Syndrome (PCOS)

    This workshop on polycystic ovary syndrome was the first workshop of the program now known as Pathways to Prevention (P2P). Previously named the Evidence-based Methodology Workshop (EbMW) program, the P2P program was renamed in 2013 to better reflect the overarching goal of the program.

    Workshop Materials


    Polycystic ovary syndrome (PCOS) is a common hormone disorder that affects approximately 5 million reproductive-aged women in the United States. Women with PCOS have difficulty becoming pregnant (i.e., are infertile) due to hormone imbalances that cause or result from altered development of ovarian follicles. One such imbalance is high blood levels of androgens, which can come from both the ovaries and adrenal gland. Other organ systems that are affected by PCOS include the pancreas, liver, muscle, blood vasculature, and fat.

    In addition to fertility impairment, other common symptoms of PCOS include:

    • Irregular or no menstrual periods (for women of reproductive age)
    • Acne
    • Weight gain
    • Excess hair growth on the face and body
    • Thinning scalp hair
    • Ovarian cysts.

    Women with PCOS are often resistant to the biological effects of insulin and, as a consequence, may have high insulin levels. As such, women with PCOS are at risk for type 2 diabetes, high cholesterol, and high blood pressure. Obesity also appears to worsen the condition. Costs to the U.S. healthcare system to identify and manage PCOS are approximately $4 billion annually; however, this estimate does not include treatment of the serious conditions associated with PCOS.


    For most of the 20th century, PCOS was a poorly understood condition. In 1990, the National Institutes of Health (NIH) held a conference on PCOS to create both a working definition of the disorder and diagnostic criteria. The outcome of this conference, the NIH Criteria, served as a standard for researchers and clinicians for more than a decade. In 2003, a consensus workshop in Rotterdam developed new diagnostic criteria, the Rotterdam Criteria.

    Workshop Goals

    The 2012 NIH Evidence-based Methodology Workshop on PCOS sought to clarify:

    • Benefits and drawbacks of using the Rotterdam Criteria
    • The condition’s causes, predictors, and long-term consequences
    • Optimal prevention and treatment strategies.

    Sponsoring NIH Institutes, Centers, and Offices

    The workshop was co-sponsored by: