Polycystic ovary syndrome (PCOS) is often misunderstood. A common myth is that ovarian cysts must be present to confirm a diagnosis. In reality, you can have PCOS without any cysts appearing on an ultrasound.
At Sirona Women’s Health in Brisbane, our all-female GP team offers expert, compassionate care for women with hormonal concerns, including PCOS, whether or not cysts are visible.
What Is PCOS?
PCOS is a hormonal condition that affects up to 1 in 10 women of reproductive age. It disrupts ovulation and can lead to symptoms such as irregular periods, acne, excess facial or body hair, and challenges with weight or fertility.
Diagnosis is made using the Rotterdam criteria, which require at least two of the following:
- Irregular or absent menstrual periods
- Signs of excess androgens (e.g. acne, unwanted facial or body hair, or elevated testosterone)
- Polycystic-appearing ovaries on ultrasound
This means ovarian cysts are not required for a diagnosis. You can still be diagnosed with PCOS if you have irregular periods and signs of androgen excess, even if your ultrasound appears normal.
Why Might There Be No Cysts on Ultrasound?
There are several reasons why someone with PCOS might not have visible cysts:
Hormonal Imbalance Without Structural Changes
The core issue in PCOS is hormonal. Ovulation may still be disrupted even without physical signs like cysts on imaging.
Variation in Ovarian Appearance
The number and appearance of ovarian follicles can vary between individuals and even from cycle to cycle. Some women naturally do not form many follicles, while others may fall just below the diagnostic threshold.
Ultrasound Limitations
Ultrasound quality, timing of the scan, and technician expertise can all impact whether or not cysts are identified. Transvaginal scans are typically more sensitive than abdominal ultrasounds.
What Should You Do If You Suspect PCOS but No Cysts Are Found?
If you experience any of the following, speak to your GP:
- Irregular or missed periods
- Acne, unwanted hair growth, or hair thinning
- Difficulty managing weight
- Fatigue, low mood, or fertility concerns
Your doctor may order blood tests to evaluate hormone levels, insulin resistance, and thyroid function. Even in the absence of ovarian cysts, these tests can help confirm or rule out PCOS.
It’s also important to exclude other causes of similar symptoms, such as thyroid dysfunction, high prolactin, or hypothalamic amenorrhoea.
When to Seek Help
You don’t need to wait for a formal diagnosis to get support. PCOS can affect your physical, emotional, and reproductive health, whether or not you have cysts. If you notice:
- Menstrual irregularity
- Signs of hormonal imbalance
- Persistent fatigue or weight gain
- Difficulty conceiving
…it’s time to speak with a GP.
Managing PCOS Without Ovarian Cysts
Management is tailored to your symptoms and goals. Treatment may include:
- Lifestyle changes, low-GI diets, strength-based exercise, and sleep support
- Hormonal therapies, such as the oral contraceptive pill or anti-androgen medications
- Insulin-sensitising agents (e.g. metformin)
- Nutritional supplements targeted to your hormonal profile
At Sirona Women’s Health in Brisbane, our experienced GPs provide personalised, holistic care to help you manage symptoms and feel your best, regardless of what shows up on your scan.
Get Personalised PCOS Management
If you’re experiencing signs of PCOS but your ultrasound shows no cysts, you’re not alone and your symptoms are still real and worth investigating. PCOS looks different for every woman, and a clear diagnosis is the first step toward feeling better.
At Sirona Women’s Health in Brisbane, our experienced female GPs are here to listen, provide clarity, and tailor a plan that works for your body and goals.Book your consultation online or contact our friendly team today to get started.