PCOS, or polycystic ovary syndrome, is a hormonal disorder driven by excess male hormone production. PCOS affects between 5 and 10% of reproductive-aged women, and tends to cause hallmark symptoms like multifollicular (also called polycystic) ovaries, menstrual irregularities, hirsutism, weight gain, and acne.1
It is important to note that many women with PCOS do not have cysts on their ovaries. The condition is a bit of a misnomer this way–you do not have to have a ton of (or any) cysts on your ovaries to qualify for a PCOS diagnosis.2
5 million women in the United States with PCOS sounds like a lot, but it’s actually estimated that less than half of all women with PCOS are diagnosed correctly. The rest may feel confused or too embarrassed to talk to medical professionals about their symptoms.
PCOS is not curable, but it is manageable. It's diagnosed based on bloodwork and medical imaging, and can be treated with medication and lifestyle changes.
A diagnosis of PCOS can be made when 2 of the 3 following symptoms are present:
With PCOS, many follicles swell and produce fluid in preparation for ovulation, but too much androgen and too little progesterone curbs the maturation process. Instead of receding back into the ovaries, the fluid-filled cysts will sometimes remain where the immature follicles formed. Many of these cysts will resolve spontaneously, but occasionally they can burst. That painful experience is known as an ovarian cyst rupture. Both cysts and ruptures can be confirmed via a pelvic ultrasound, a noninvasive medical imaging scan that uses sound waves to capture images of your reproductive organs and any fluid in the surrounding cavities.
A “standard” menstrual cycle is 28 days long, with ovulation falling somewhere around day 15. That makes the first half (the follicular phase) of the cycle 14 days, and the second half (the luteal phase) 14 days as well. These consistent numbers make both ovulation and menstruation quite predictable each month.
For women with PCOS, however, the follicular phase is almost never a standard 14 days, and it can fluctuate in length from cycle to cycle. Some women won’t ovulate until day 21 or 28; some will literally go months without ovulating at all (which also means they will go months with no periods). Unless they’re pretty keyed into their bodies’ signs of ovulation or are tracking ovulation with urine tests, it can be hard for women with PCOS to know when they’re fertile or when they can expect their period to come. This difficulty pinning down the fertile window each cycle can make getting pregnancy difficult. In fact, PCOS is a leading cause of infertility.
Other common symptoms of PCOS include:
Both transabdominal and transvaginal ultrasounds can create clear images of the ovaries, including any follicles and/or cysts. In the follicular phase, a normal ultrasound of the ovaries will show a few follicles, with a dominant follicle noticeably larger than the others. That follicle will release the egg at the time of ovulation, while the nondominant follicles gradually recede back into the ovary.
An ovary with PCOS, however, can have more than 12 follicles on each ovary. This multifollicular pattern can be unilateral (on just one ovary) or bilateral (on both ovaries) and often presents in a ring or PCOS-classic “string of pearls” pattern.
Once a diagnosis of PCOS has been made, there are several ways to treat it and manage its symptoms:
Don’t let embarrassment prevent you from disclosing things like facial hair, balding, and adult acne to your doctor. They’re important pieces of the PCOS puzzle, and the first step to treating your symptoms is getting the correct diagnosis.
If you think you might be dealing with PCOS, ask your doctor if a diagnostic ultrasound might be right for you. Imaging centers near you are easy to find using scan.com’s scan search tool.
pennmedicine.org: 5 Myths About Polycystic Ovary Syndrome (PCOS) - Penn Medicine
hopkinsmedicine.org: Polycystic Ovary Syndrome (PCOS) | Johns Hopkins Medicine
nlm.nih.gov: National Library of Medicine
pcosaa.org: PCOS Awareness Association