Polycystic Ovary Syndrome, or PCOS, is a common hormonal condition that affects women of reproductive age. It involves a wide range of symptoms, from irregular menstrual cycles to metabolic issues. Because of its varied presentation, doctors use several tools to reach a diagnosis. One of these is medical imaging, which allows for a direct look at the ovaries as part of a comprehensive evaluation.
Why Ultrasound Is Used for PCOS Diagnosis
An ultrasound is part of the diagnostic process for PCOS because it allows a doctor to visually inspect the ovaries for specific features. The most widely used guidelines, the Rotterdam criteria, state that a diagnosis requires meeting at least two of three specific conditions. These conditions are irregular or absent periods, high levels of androgens, and the presence of polycystic ovaries on an ultrasound scan.
This means that an ultrasound by itself cannot diagnose PCOS. The imaging results must be considered alongside a patient’s symptoms and blood tests that measure hormone levels. The primary purpose of the ultrasound is to determine if the ovaries have a particular appearance known as polycystic ovarian morphology (PCOM).
What Doctors Look For on a PCOS Ultrasound
When examining an ultrasound for signs of PCOS, one of the most well-known signs is the “string of pearls” appearance. This term describes ovaries that are lined with many small, undeveloped follicles. These follicles are tiny, fluid-filled sacs where eggs are supposed to develop, but in this case, they have not matured properly.
To make a formal determination, radiologists use specific, measurable thresholds. According to updated 2018 guidelines, the presence of 20 or more follicles in at least one ovary is a marker for polycystic morphology. An ovarian volume greater than 10 milliliters (mL) is also considered a sign.
In addition to follicle count and ovarian volume, advanced 3D ultrasound techniques can measure the ovarian stroma, which is the supportive tissue within the ovary. In individuals with PCOS, this stromal tissue is often thicker and more prominent. This thickening is linked to the increased production of androgens, a central aspect of the syndrome.
How the Ultrasound Is Performed
For evaluating the ovaries for PCOS, the preferred method is a transvaginal ultrasound. This technique provides much clearer and more detailed images of the pelvic organs compared to a transabdominal ultrasound because the probe is positioned closer to the ovaries.
The procedure involves placing a small, wand-like device called a transducer into the vagina. This transducer emits sound waves that travel through the body and bounce off the organs, creating echoes. A computer then translates these echoes into real-time images on a screen, allowing the doctor to see the size, shape, and texture of the ovaries and uterus.
This is a routine and quick procedure, lasting only a few minutes. While it may cause some mild pressure or discomfort, it is not considered painful. The detailed view it provides is important for accurately counting follicles and measuring ovarian volume.
Understanding Your Ultrasound Report
Receiving an ultrasound report that mentions “polycystic-appearing ovaries” can be confusing. This result on its own does not mean you have PCOS. It is possible for someone to have ovaries with this appearance without having the syndrome, as polycystic ovarian morphology can be a normal variation in some individuals, particularly adolescents.
Conversely, not everyone with a confirmed diagnosis of PCOS will show polycystic ovaries on an ultrasound scan. A person can still be diagnosed if they meet the other two criteria of irregular periods and high androgen levels.
The results of the scan should always be discussed with your healthcare provider. They will interpret the report in the context of your specific symptoms, medical history, and blood test results. This complete picture is necessary to determine if a PCOS diagnosis is appropriate and to develop a management plan tailored to your needs.