PCOS cannot be acurately diagnosed via ultrasound

Did you know that Poly Cystic Ovarian Syndrome (PCOS) cannot *accurately* be diagnosed or ruled out via ultrasound? CRAZY huh.

As we discussed earlier, the term PCOS is actually a misnomer - PCOS has nothing to do with cysts on the ovaries, it is largely a METABOLIC condition. Put simply, elevated hormone insulin impairs ovulation, and stimulates the ovaries to make testosterone instead of oestrogen. Polycystic ovaries (PCO) is a variant of normal ovaries, while polycystic ovarian syndrome is a metabolic disorder associated with hormonal imbalance.

Normal ovaries are filled with ovarian follicles, and those follicles are small normal “cysts”. Every month, those normal cysts grow, the dominant follicle bursts to release an egg, and the remainder of cysts/follicles are reabsorbed. Up to a third of women of childbearing age have polycystic looking ovaries on ultrasound and no other symptoms. PCOS, on the other hand, affects 12-18% of women of reproductive age.

  • It is completely normal to have up to 12 follicles in your ovaries if you are an adult, and up to 25 if you are a teenager. Therefore “polycystic looking ovaries” are entirely normal for teenagers. 

  • If you don’t ovulate, you will not form a dominant follicle which suppresses the other follicles. Instead the other follicles will keep growing too, until you end up with many small undeveloped follicles - which are then called “cysts”. 

  • The appearance of “polycystic looking ovaries” could simply mean that you just didn’t ovulate that month - it doesn’t mean your ovaries always look that way. One study found that healthy women have PCOS looking ovaries 25% of the time. 

So, if PCOS cannot be diagnosed accurately via ultrasound, then how is it diagnosed? 2 out of 3 of the following symptoms are required:

  • Signs of elevated androgens or testosterone: male pattern hair growth (facial hair, hairy nipples, snail trail), male pattern baldness, acne, and/or elevated androgens on a blood test. 

  • Long Irregular cycles (>35 days) or anovulation.

  • Poly cystic looking ovaries on an ultrasound. 

What this means is:

  • You can have normal looking ultrasound and still have PCOS

  • You have have poly cystic looking ovaries on an ultrasound, and not have the condition 


Confusing much? Tell me about it! If you need help, book a naturopathic consultation to assess your hormone puzzle.

Hayley Brass