Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects many women around the globe. Women suffering from PCOS often experience irregular menstrual cycles, high levels of male hormone production, enlarged ovaries containing small cysts, and potentially a number of negative health concerns including fertility issues, resistance to insulin, and significant mental distress.
Ultrasounds for PCOS is a highly beneficial diagnostic and management tool for women diagnosed with PCOS. In this article, i will explain how ultrasounds for PCOS work, what to expect during the procedure, how results are interpreted, and their role in accurate diagnosis.
What is polycystic ovarian syndrome (PCOS)?
PCOS (Polycystic Ovary Syndrome) is very common in Australia, affecting approximately 1 in 8 women. Many women with PCOS experience issues such as irregular menstruation, increased body hair, skin problems and difficulty with conception/infertility. PCOS is characterized by hormonal dysregulation (increased testosterone and decreased estradiol) and insulin resistance.
These two factors can have significant negative effects on a woman’s metabolic health, therefore it is important that women diagnosed early in their disease process. Early diagnosis through Ultrasounds for PCOS, doctors can assist women diagnosed with PCOS make lifestyle changes, initiate treatment with medication, and provide fertility support through medicare.
Why are Ultrasounds used for PCOS diagnosis?
A doctor can use ultrasounds to see the ovaries and uterus clearly. Ovaries from women who have PCOS often appear larger than those from women without the disorder because they contain multiple smaller follicles, which represent immature egg sacs (not true cysts).
Reasons for using Ultrasounds for PCOS:
-
To check the Ovary Size and Shape: Ovarian volumes are generally measured through ultrasound. Ovaries in women with PCOS usually have volumes more than 10 mL, indicating that they contain excess tissue, fluid, and follicles. Ovaries that are enlarged and round are indicative of polycystic changes. These structural changes can be used doctors to evaluate the severity of PCOS-related symptoms and monitor responses to treatment.
-
To Spot Multiple Small Follicles: On ultrasound, the PCOS ovary will have 20 or more immature egg follicles located in a ring along the edges of the ovaries, appearing like a pearl necklace in appearance. The count these across the whole ovary in multiple slices, confirming the key visual hallmark and this differentiates PCOS from normal variation where follicles are fewer.
-
To rule out ovarian cysts or tumors: Ultrasounds can also help to exclude alternative diagnoses, such as large cysts, tumors, or twisting of the ovaries causing similar symptoms. They also help to identify abnormalities such as solid masses or fluid-filled masses that could require surgical intervention. With high-quality images, ultrasound can provide diagnostic proof that is used to support a diagnosis of PCOS rather than a misdiagnosis of another treatable condition.
-
To support Diagnosis with Symptoms & Blood Tests: A single diagnostic test cannot confirm a diagnosis of PCOS, and ultrasound can again provide supportive evidence for fulfilling one of the Rotterdam criteria along with other indicators, including irregular menstrual cycles, excessive body hair or acne, and testosterone levels for a diagnosis. By providing objective evidence through ultrasound, over-diagnosis of PCOS in young women or lean women can occur.
Types of Ultrasounds for PCOS
There are 2 main types of ultrasounds used in diagnosing PCOS:
Transvaginal Ultrasound
An internal scan uses a thin probe placed inside the vagina and provides high-quality views of the ovaries that are well suited for adults. An internal scan uses very high frequency sound waves to allow the accurate counting of small follicles and for volume measurements. It is the preferred tool for diagnosis of PCOS as it allows high-quality imaging of the ovaries without any interference from the abdomen.
Transabdominal Ultrasound
An external scan uses gel applied to the lower abdomen and requires use of a full bladder. External scans provide less detailed imaging than transvaginal scans, and therefore are often used for children, virgins or individuals who do not want a transvaginal scan. External scans are also mainly used as the pre-test to determine whether the transvaginal scan can be used. Often used for individuals with a BMI too high to allow the use of transvaginal scans.
In Australia, both types are widely available at radiology clinics and are generally covered by Medicare when referred by a doctor.
How are ultrasounds for PCOS performed?
If you are scheduled for both abdominal (external) and transvaginal (internal) ultrasounds for PCOS, here’s what to expect:
- Many patients are asked to arrive with a full bladder for abdominal ultrasounds because this can help tilt organs into better positions for clearer pictures and enhance sound wave conduction.
- The patient will lie on their back on the exam table for the abdominal section of the test. A conductive gel will be placed after the abdomen has been accessed.
- When particular positions are reached, the radiologist will glide the transducer around the abdomen, taking pictures on a computer.
- The patient will be asked to empty their bladder and return for the internal component of the scan after the abdominal section (if required), changing into a hospital gown beforehand.
- Before vaginal insertion, the transducer will be covered with gel while the patient lies on the exam table. As with the abdominal part, images of the ovaries will be taken from this position.
- Once the exam is complete, the patient can resume their regular activities.
Benefits of Ultrasound in PCOS Management
Ultrasound is beneficial for managing PCOS because it has many uses right from diagnosis through to ongoing management resulting in positive health outcomes for Australian women.
-
Early Detection of PCOS: Ultrasound helps to identify PCOS early where there are multiple small follicles allowing women to receive timely medical before you develop complications like infertility or diabetes. Also, by detecting PCOS in your 20s or 30s using routine pelvic scans you can proactively change your lifestyle habits under Medicare.
-
Accurate Diagnosis of PCOS: Ultrasound provides clear images of enlarged ovaries and clusters of follicles, supporting the Rotterdam criteria for PCOS. They help provide confirmation of PCOS beyond symptoms and blood tests. They result in less misdiagnosis ensuring that you are given an accurate diagnosis so that you do not take any unnecessary medication.
-
Guidance for Treatment Options: Ultrasound will continue to monitor the size of your ovaries and the number of follicles while you are undergoing treatment with metformin, trying to lose weight or using a contraceptive, allowing you to see improvements. This helps doctors adjust treatment plans as needed.
-
Fertility Guidance: If you are trying to conceive, ultrasounds monitor the development of maturing follicles and can help determine when you will ovulate as well as the thickness of your uterine lining, thus helping to optimise your IUI/IVF cycles at any clinic, including IVF Australia.
- Visual Understanding: Seeing images of your ovaries provides a visual representation that can motivate you to have better discussions with your doctor and motivate you to make changes in your lifestyle. Seeing your string of pearls of follicles also gives you the confidence to advocate for yourself in your appointments.
Ultrasound Results: What to expect
After your ultrasound for PCOS, a trained radiologist will carefully review all images captured images of your ovaries and uterus to assess features like follicle counts and ovarian size. The radiologist can then prepare a report with detailed information regarding measurements and various sample pictures of the organ systems that were examined during the ultrasound and send that information back to your GP or gynecologist usually within hours or even the same day.
Usually, this is done via secure electronic systems like My Health Record in Australia. At your next appointment, your doctor/GP will discuss the results of your ultrasound context with your symptoms and test results and outline the steps you need to take next, which may include recommendations on a PCOS Diet Plan, lifestyle changes, prescription medications, or other tests.
Final Words
Ultrasounds are an important diagnostic tool for PCOS. However, in Australia, they are just one part of the overall diagnostic process as doctors will investigate all aspects including: Symptoms; Blood tests; Imaging. If you are concerned that you have PCOS please see your doctor and get the proper testing done and not just rely on what you read about the condition online. If you are diagnosed and have the right treatment for PCOS from an early stage this will help you in improving quality of life, overall reproduction health and long-term health.
FAQ's
Can Ultrasounds detect PCOS early?
Ultrasounds can assist in identifying early changes to the ovaries; however, diagnosing PCOS in younger women (teenagers/young adults especially) can be challenging.
Are ultrasounds for PCOS safe?
Yes ultrasounds for PCOS are completely safe, if done under a qualified radiologist.
How long does the ultrasound take?
Most ultrasound scans will last between 15-30 minutes.
Can ultrasound alone diagnose PCOS?
No, ultrasound alone cannot diagnose PCOS. It is used along with clinical symptoms and lab tests to arrive at an accurate diagnosis.
References:
- pmc.ncbi.nlm.nih.gov/articles/PMC11853298/
- www.pockethealth.com/patient-resources/pcos-ultrasound/
- womenshealth.org.au/sexual-and-reproductive-health/polycystic-ovary-syndrome-pcos/
- www.racgp.org.au/afp/2012/october/polycystic-ovary-syndrome
