PCOS cannot be diagnosed by ultrasound

First scenario: So you have irregular cycles, putting on weight, have had an ultrasound - cysts on ovaries and now diagnosed with PCOS.

Second scenario: You have irregular cycles, putting on weight, have had an ultrasound - no cysts on ovaries so PCOS is ruled out.

I have had soooo many people come to me in clinic in both of these scenarios who are left with no answers or treatment options.


Did you know that PCOS cannot be diagnosed by ultrasound alone?

This is because polycystic ovaries are not cysts. They’re follicles or eggs which are very much normal for the ovary.

It is normal for women to have a higher number of follicles. It is normal for young women to always have a high number of follicles - this is because young women have more eggs!

This is why PCOS cannot be diagnosed OR ruled out by ultrasound alone.

It is actually possible to have normal-looking ovaries on the ultrasound but still have the hormonal condition PCOS.

My opinion is that the name of PCOS is very deceiving and should be renamed (haha).


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Identifying PCOS:

PCOS can be a complex condition to identify as there are numerous symptoms and you don’t have to have them all to be diagnosed with PCOS. Very few women have the same symptoms picture and the symptoms can change at different stages in your life.

The three main areas affected are:

  • Fertility & reproductive health

  • Metabolic health

  • Psychological health



What is the criteria to be diagnosed (or ruled out) PCOS?

12-21% of women of child-bearing age are affected by polycystic ovarian syndrome with up to 70% of women undiagnosed (1)

A diagnosis of PCOS can be made when at least two of the following three criteria are met:

  1. Irregular periods or no periods

  2. Hyperandrogenism (Higher levels of androgens are present in the blood) shown by:

    a blood test, OR

    symptoms such as:

    excess facial or body hair growth

    scalp hair loss

    acne

  3. Polycystic ovaries are visible on an ultrasound, meaning:

    • more than 20 follicles (partly developed eggs) are visible on one or both ovaries or

    • the size of one or both ovaries is increased (more than 10ml).


You do not need to have an ultrasound if you have criteria 1 and 2.

In women younger than 20 years, ultrasounds are not recommended. This means that irregular periods and hyperandrogenism need to be present for a diagnosis of PCOS to be made.

A number of other conditions that could cause similar symptoms of irregular periods or no periods need to be checked by your doctor and ruled out before a correct diagnosis of PCOS can be confirmed.


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  1. Ajmal, N. (2019, June 8). Polycystic ovary syndrome (PCOS) and genetic predisposition: A review article. PubMed. https://pubmed.ncbi.nlm.nih.gov/31403134/

Ellen Tattam