Polycystic Ovary Ultrasound: what does a PCOS Ultrasound Show?

Polycystic ovary ultrasound: what does a PCOS ultrasound show?

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.

What is PCOS?

A diagnosis of PCOS can be made when 2 of the 3 following symptoms are present:

1. Enlarged or cyst-covered ovaries. Ovulation is complex; the right number and ratio of hormones need to be present for an ovarian follicle to develop to maturity and release an egg.

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.

2. Irregular periods. Because high androgen levels and low progesterone levels prevent normal ovulation from occurring, PCOS menstrual cycles are often irregular.

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.

3. Signs of excess androgen. Hair missing where you want it, and growing where you don’t.

• Male-pattern baldness. Some women with PCOS will notice hair thinning around the crown of their head and in the front of their part.
• Hirsutism. Excess male hormone levels unfortunately also leads to a higher incidence of male pattern facial and body hair. Women with PCOS may experience coarse, dark hair growth along the chin, jaw, cheeks, neck, chest, stomach, and back.
• Acne. Because of excess androgen, women who are diagnosed with PCOS are significantly more likely than women without it to have acne and oily skin.

Other common symptoms of PCOS include:

• Weight gain, especially around the abdomen. About 80% of women with PCOS are overweight. This may be related to insulin resistance, which occurs when the body can’t use its insulin well or effectively. Insulin buildup can trigger excess androgen production which, in turn, activates symptoms of PCOS. However, not all women with PCOS are overweight. “Lean PCOS” accounts for about 20% of all PCOS cases.³
• Fatigue.
• Depression.
• Headaches.
• Dark patches of skin around the arms, neck, or breasts that have a velvet-like consistency.⁴

What does a PCOS ultrasound image look like?

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.

How is PCOS treated?

Once a diagnosis of PCOS has been made, there are several ways to treat it and manage its symptoms:

• Oral contraceptive (birth control) pills.
• Anti-androgenic medications.
• Insulin-controlling medications.
• Ovulation-inducing medications (helpful if you’re trying, but struggling, to get pregnant).
• A healthy diet and regular exercise.

Schedule your pelvic ultrasound

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.

Resources:

1. pennmedicine.org: 5 Myths About Polycystic Ovary Syndrome (PCOS) - Penn Medicine

2. hopkinsmedicine.org: Polycystic Ovary Syndrome (PCOS) | Johns Hopkins Medicine

3. nlm.nih.gov: National Library of Medicine 

4. pcosaa.org: PCOS Awareness Association