Q: I don’t get it. My doctor just said I could have PCOS, but she also said I don’t have any ovarian cysts. Is that right?!
A: In a word: Yes!
Polycystic ovarian syndrome, also known as PCOS, is present when a person has two or more of the following:
- Irregular periods.
- Excess testosterone, which can be found with a blood test and is demonstrated by acne and by excess hair growth, known as hirsutism, on the face, chest or back.
- Multiple ovarian cysts seen on an ultrasound.
So, for example, if you have irregular periods and extra facial hair, you could have PCOS even if multiple cysts aren’t found on your ovaries.
Typically, people with PCOS have periods only once in a while, often skipping months between periods. If you have this bleeding pattern, tell your health care team. You might need to have hormone blood tests and maybe a pelvic ultrasound to look at your ovaries and uterus. If you have irregular periods and excess testosterone as shown on a blood test, a health care provider can make the diagnosis of PCOS even without an ultrasound.
However, PCOS is not the only condition that can cause irregular periods. For this reason, care teams often use blood tests to check for other possible health issues, such as a problem with thyroid function. Certain medications like birth control pills, metformin (Fortamet, Glumetza) and spironolactone (Aldactone, Carospir), can cause false results. So make sure your care team knows all the medications you’re taking before you get any bloodwork done.
If you’re diagnosed with PCOS and you’re not having periods every month, talk to your care team about treatment options. The team might recommend medication — such as birth control pills — that can regulate your hormones to protect you from developing uterine growths like polyps or cancer. When taking these medications, you still might not have a monthly period, but that’s OK. While it’s important to regulate your hormones, there’s no benefit or need to bleed each month.
Be sure to mention if you are thinking about getting pregnant, as that will rule out birth control as a medication option. And sometimes people with PCOS will need additional support when trying to conceive.
People with PCOS can have issues with insulin resistance, which means they can struggle with weight and have high blood sugar or even diabetes. PCOS also puts you at higher risk of heart disease, depression and sleep apnea. It’s always a good idea for people with PCOS to have an internal medicine or primary care provider monitor their health regularly.
What about ovarian cysts? It’s important to know that most ovarian cysts aren’t cause for concern!
The first part of the menstrual cycle is known as the follicular phase. During this time, increases in a certain hormone signal a group of immature eggs to begin developing. For younger people, perhaps 15 to 20 eggs enter this phase in any given month, but typically only one egg matures enough to be ovulated.
The immature eggs are contained in fluid-filled sacs called follicles. Eventually, a single follicle becomes the dominant one, outcompeting the rest and growing in size until it is about an inch in diameter. At this point, the rest of the follicles gradually stop developing and dissipate.
So if your ultrasound shows cysts, they are usually just typical, healthy follicles that fluctuate over time. These follicles resolve on their own and don’t cause pelvic pain or period problems. Your health care team uses ultrasound to determine what kind of cysts you have and if other tests or treatment is needed.
With PCOS, numerous immature follicles reside in the ovaries, waiting for the right signal to get the ovulation process started. But for some reason — possibly a hormone imbalance — the signal doesn’t come, so too many follicles grow at the same time.
Remember: The diagnosis of PCOS is based on three criteria and polycystic ovaries is only one of those. So, if you’re having irregular periods and you have acne or excess hair growth on your face, chest or back, you might have PCOS. All of these symptoms are good reasons to talk to your health care team to determine if additional testing or treatment is needed.
