From the Guidelines
Yes, you can have Polycystic Ovary Syndrome (PCOS) without visible cysts on your ovaries. PCOS is diagnosed based on a combination of factors, not just the presence of ovarian cysts. According to current diagnostic criteria, you need at least two of the following three features: irregular or absent periods, elevated androgens (male hormones) detected by blood tests or physical signs like excess facial hair or acne, and polycystic ovaries on ultrasound 1. This means that if you have irregular periods and high androgen levels, you can be diagnosed with PCOS even without ovarian cysts.
The diagnostic criteria for PCOS are based on the International Evidence-based Guideline Criteria, which include ovulatory dysfunction, clinical or biochemical hyperandrogenism, and/or polycystic ovary morphology (PCOM) on ultrasound or elevated anti-Müllerian hormone levels 1. The presence of ovarian cysts is not a requirement for diagnosis, and treatment focuses on managing symptoms and addressing hormonal imbalances through lifestyle changes, hormonal contraceptives, anti-androgen medications, or insulin-sensitizing drugs like metformin, depending on your specific symptoms and health goals.
Some studies have evaluated the diagnostic accuracy of ultrasonographic ovarian markers in the diagnosis of PCOS, including the use of polycystic ovary morphology (PCOM) as a diagnostic criterion 1. However, the presence of PCOM is not necessary for a diagnosis of PCOS, and other factors such as hormonal imbalance and ovulatory dysfunction are also important considerations.
Key points to consider in the diagnosis of PCOS include:
- Irregular or absent periods
- Elevated androgens (male hormones) detected by blood tests or physical signs like excess facial hair or acne
- Polycystic ovaries on ultrasound (although not required for diagnosis)
- Hormonal imbalance, particularly insulin resistance, which affects ovulation and hormone production regardless of whether cysts are present 1.
Overall, the diagnosis of PCOS is based on a combination of clinical, biochemical, and ultrasonographic features, and the presence of ovarian cysts is not a requirement for diagnosis. The focus of treatment should be on managing symptoms and addressing hormonal imbalances, rather than solely on the presence or absence of ovarian cysts.
From the Research
Definition and Diagnosis of PCOS
- Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting women of childbearing age, characterized by insulin resistance, hyperandrogenism, and ovulation abnormalities 2.
- The diagnosis of PCOS is primarily clinical, based on the presence of at least two of the three Rotterdam criteria: oligoanovulation, hyperandrogenism, and polycystic ovaries on ultrasonography 2, 3.
PCOS without Cysts on Ovaries
- According to the Rotterdam criteria, PCOS can be diagnosed without the presence of polycystic ovaries on ultrasonography, as long as the other two criteria (oligoanovulation and hyperandrogenism) are met 2, 4.
- The presence of polycystic ovaries is not a mandatory criterion for the diagnosis of PCOS, and some women with PCOS may not have cysts on their ovaries 3, 5.
Treatment and Management of PCOS
- Lifestyle modification, including caloric restriction and increased physical activity, is the foundation of therapy for PCOS 2.
- Medications such as metformin, oral contraceptives, and antiandrogens may be used to manage symptoms and regulate menstruation 2, 6, 4.
- The treatment of PCOS depends on the prevailing symptoms and the patient's desire for pregnancy 2, 5.