Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age. It often leads to irregular periods, excessive hair growth, acne, and difficulty with ovulation. One of the diagnostic tools doctors commonly use is the pelvic ultrasound scan; but can this scan alone confirm PCOS?
What Is PCOS?
PCOS is a condition where a woman’s ovaries produce more androgens (male hormones) than normal. This hormonal imbalance can interfere with egg development and release, leading to irregular menstrual cycles or infertility.
Common symptoms include:
- Irregular or absent periods
- Weight gain or difficulty losing weight
- Acne or oily skin
- Excess facial or body hair
- Thinning hair on the scalp
- Difficulty getting pregnant
What Does a Pelvic Ultrasound Show?
A pelvic ultrasound uses sound waves to create images of your pelvic organs, primarily your uterus and ovaries. When assessing for PCOS, the focus is on the ovaries.
With PCOS, the ultrasound may show:
- Enlarged ovaries
- Multiple small follicles at the edges of the ovary
Doctors usually look for 12 or more follicles measuring 2–8mm in each ovary or an ovarian volume greater than 10 cm³.
This finding is known as polycystic ovarian morphology (PCOM).
Can PCOS Be Diagnosed by Ultrasound Alone?
Not always. While an ultrasound can show features suggestive of PCOS, diagnosis requires more than imaging. The Rotterdam Criteria (one of the most widely used diagnostic standards) state that a diagnosis is made when at least two of the following are present:
- Irregular or absent ovulation
- Clinical or lab signs of excess androgens (like acne, hirsutism, or elevated hormone levels)
- Polycystic ovaries on ultrasound
So, if your scan shows polycystic ovaries but your periods are regular and you don’t have signs of hormonal imbalance, you do not have PCOS.
Can You Have PCOS Without Cysts?
Yes! Many women with PCOS do not show cysts on their ultrasound—especially if they're on birth control pills or have recently ovulated. Similarly, some women may have polycystic ovaries but no symptoms of PCOS.
Other Conditions That Look Like PCOS on Ultrasound
Certain conditions can mimic the appearance of PCOS, including:
- Normal ovaries in young women (it’s common to have multiple small follicles)
- Ovarian hyperstimulation with medications
- Hypothyroidism or other endocrine disorders
That’s why it’s essential for ultrasound findings to be interpreted in the context of your symptoms, medical history, and hormone tests.
Final Thoughts
A pelvic ultrasound is an important piece of the puzzle, but it’s not the full picture. If you're experiencing symptoms like irregular periods, acne, or weight changes, speak to your doctor. They may recommend a combination of blood tests and ultrasound to determine whether you have PCOS.
Early diagnosis and management can help prevent complications like infertility, type 2 diabetes, or heart disease.
📍 Mascot Healthcare offers expert pelvic ultrasound scans and hormonal assessments for women in Lagos. If you're wondering about PCOS or have concerns about your menstrual cycle, book a consultation with us today.