If your PCOS was diagnosed by ultrasound, it may not be an accurate diagnosis. The so-called ‘cysts’ have very little to do with your actual condition. And no, the cysts will not cause weight gain and infertility and heart disease.
But the word ovary appears in the very name of the condition polycystic ovarian disease. So it must be an ovarian disease? Right? Wrong.
In truth, your ovaries are not to blame at all. With the right nutritional support, your ovaries can and will go back to doing exactly what they’re supposed to do.
True and false about PCOS
Cysts are normal for ovaries. Because cysts are the sacs or follicles that contain the eggs. (And what would an ovary be without those?) Every month, your ovaries grow new follicles grow and then reabsorb them. So every month, your ovaries will have a completely different set of follicles. And every month, your ovaries will look different on ultrasound.
The normal ovary should have—on average—6 to 12 variously sized follicles (more when you’re younger). The polycystic ovary has—by definition—more than 12 small undeveloped follicles (more than 25 when you’re younger).
But why are the follicles small and undeveloped? Because ovulation did not occur that month. The ultrasound cannot explain why ovulation did not occur, nor can it predict whether ovulation will occur the next month. Sometimes ovulation just doesn’t happen, and that’s why normal women have polycystic ovaries 25 percent of the time . Test them again in a few months, and their ovaries will be normal. That’s why all experts agree that PCOS cannot be diagnosed by ultrasound.
(A quick note about other types of abnormal ovarian cysts. There are large functional cysts—which are the most common ‘ovarian cyst’— and can grow to 5 cm or larger, and sometimes require surgery. There are also pathological ovarian cysts such as dermoid cysts, hemorrhagic cysts and the chocolate cysts of endometriosis. Those are completely different sorts of problems, and do not enter into the discussion about polycystic ovarian syndrome.)
The story that I hear most often runs something like this: 1) went on the Pill as a teenager for skin, 2) came off the Pill in 20s or 30s, 3) periods don’t show up (probably because of post-pill syndrome), 4) acne flares up (because of Pill-withdrawal), 5) ultrasound shows ovaries have a polycystic appearance, 6) doctor diagnoses PCOS without doing any blood tests, 7) doctor prescribes the Pill.
Please understand: At times—and for all sorts of different reasons—you can face temporary obstacles to ovulation, which means you’ll have irregular periods and possibly polycystic ovaries. That does not mean that you have the hormonal condition of PCOS.
Common obstacles to ovulation include having been on the Pill, sugar, inflammation, environmental toxins, gluten, thyroid disease, prolactin, stress, nutrient deficiency, and many other things. Proper diagnosis requires a detailed health history and blood tests for hormones (including insulin, androgens, prolactin, thyroid and others).
⚠️ Tip: If you’re avoiding carbs because someone saw polycystic ovaries on ultrasound, you may be on the completely wrong track.
False: PCOS is an ovarian disease
PCOS is not an ovarian condition. It is one of several whole-body hormonal conditions (all called PCOS) that affect the ovaries. Hormones are the problem. Ovaries are the victim.
When confronted with inflammation and impaired insulin signalling and several other issues, the ovaries of some women respond by shutting down ovulation and making excess testosterone. Yes, that happens because of a genetic susceptibility. Other women without that susceptibility can face the same inflammation and insulin resistance, but their ovaries don’t make testosterone.
Still the best treatment is not to treat the ovaries, but to treat the underlying inflammation or insulin problem that is disturbing the ovaries. (See Treatment for 4 Types of PCOS.)
True: PCOS needs a name change
In January 2013, an expert panel from the NHI stated that the term PCOS is confusing. They called for PCOS to be renamed. It needs a new name, they said, because PCOS is not an ovarian condition.
Dr. Robert A. Rizza from the Mayo Clinic (and a member of the NHI panel) sums up the name change:
[The name PCOS]..focuses on a criteria – namely the polycystic ovarian morphology – that is neither necessary nor sufficient to diagnose the syndrome. It is time to assign a name that reflects the complex metabolic, hypothalamic, pituitary, ovarian, and adrenal interactions that characterize PCOS.
In July 2016, the new name was proposed to be ‘metabolic reproductive syndrome’.
Please also read:
- Treatment for 4 Types of PCOS. Treat the Cause
- 4 Causes of Androgen Excess in Women
- Chapter 7 of my book Period Repair Manual
Yours in health,