PCOS Cannot Be Diagnosed (or Ruled Out) by Ultrasound

Polycystic ovary syndrome (PCOS) cannot be diagnosed by ultrasound because polycystic ovaries are not cysts. They’re follicles or eggs which are normal for the ovary.

It’s normal for all women to sometimes have a higher number of follicles. It’s normal for young women to always have a higher number of follicles because young women have more eggs. That’s why PCOS cannot be diagnosed by ultrasound. At the same time, PCOS cannot be ruled out by ultrasound because it’s possible to have normal-appearing ovaries on ultrasound and still have the hormonal condition PCOS.

This problem of PCOS overdiagnosis is explored in a new British Medical Journal article called Driven by good intentions: why widening the diagnostic criteria for polycystic ovary syndrome may be harming women.

PCOS cannot be diagnosed by ultrasound.

In the article, the authors explain why labelling women with an unnecessary PCOS diagnosis can have harmful, lifelong consequences. They also observe that some women with hypothalamic amenorrhea (undereating) are being mistakenly told they have PCOS and that furthermore, PCOS can be temporary in some cases. In other words, PCOS can be outgrown.

Two situations of temporary PCOS


Polycystic ovaries, irregular cycles, high androgens (male hormones), and even mild insulin resistance are all normal and healthy during puberty. That’s why now experts recommend that PCOS not be diagnosed until at least three years after the onset of periods.

👉Tip: Pain is not a symptom of PCOS so if pain is your main symptom, there’s something else going on.


Post-pill PCOS is a temporary state of androgen excess when coming off the pill. It happens for several reasons:

  • Coming off an androgen-suppressing contraceptive drug such as drospirenone (Yasmin) can cause a temporary surge in androgens, which can lead to a PCOS diagnosis. Given time, post-pill PCOS usually resolves. Read 4 types of PCOS and How to prevent and treat post-pill acne.
  • Hormonal birth control can cause or worsen insulin resistance and is a major contributor to the classic insulin-resistant PCOS.
  • Hormonal birth control disrupts the healthy signalling of the HPO (hypothalamic-pituitary-ovarian) axis which can make it hard to resume ovulation once stopping the pill.

You might be thinking, “but surely I would not have been given a PCOS diagnosis when it’s only a temporary post-pill situation?” Unfortunately, yes, you could have been.

Check out my 2022 YouTube video about this topic.

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