Yes you can have pcos without cysts. For PCOS you should have aleast 2 out of these 3 symptoms such as cycts on ovaries, irregular periods and higher level of androgens. So if you have excess hair and irregular periods than you have PCOS. This blog will help you understand how PCOS is diagnosed, why cysts aren’t always present, and what this means for your health.
PCOS Beyond the Name
The name “Polycystic Ovary Syndrome” can be misleading. Many assume it’s a condition that only affects the ovaries due to cysts, but this isn’t entirely accurate. In reality, PCOS is a hormonal disorder, not just a cystic condition. The term “polycystic” refers to the appearance of the ovaries on an ultrasound, where they may show multiple immature follicles. However, these aren’t true cysts, and not every woman with PCOS has them. This confusion around the name often leads to delayed diagnosis or misunderstanding of the condition.
How PCOS Is Diagnosed: The Rotterdam Criteria
Most healthcare providers use the Rotterdam criteria to diagnose PCOS. According to this system, a woman must meet two out of the following three features:
- Irregular or missed menstrual periods (anovulation),
- Signs of high androgens (like acne, hirsutism, or elevated testosterone),
- Polycystic ovaries visible on ultrasound.
Because only two of these three features are required, it is entirely possible and very common for women to be diagnosed with PCOS without having any cysts on their ovaries.
Yes, You Can Have PCOS Without Cysts
Many women with PCOS never develop the “string of pearls” appearance on their ovaries that is often associated with the condition. In fact, some types of PCOS do not involve any visible cysts at all. For example, some women have symptoms of high androgens and irregular periods but have normal-appearing ovaries. Others may have polycystic ovaries but do not experience hormonal symptoms or menstrual irregularities. This is why PCOS is now recognized as having several different phenotypes. The presence of ovarian cysts is not required for a diagnosis.
Additionally, the term “cyst” is often misunderstood. The fluid-filled sacs seen in PCOS are actually immature follicles that haven’t ovulated. These are different from true ovarian cysts that can form due to other conditions.
Myths and Misconceptions About PCOS
One of the most common myths is that you must have cysts to have PCOS. As discussed earlier, this is not true. Another myth is that PCOS only affects overweight or obese women. While being overweight can increase the risk or worsen symptoms, many women with PCOS are lean and still experience hormonal imbalances. A third misconception is that PCOS is only a fertility issue. While it can affect ovulation, PCOS also has long-term health implications, including increased risk for insulin resistance, type 2 diabetes, high cholesterol, and mood disorders like anxiety or depression.
Diagnosing PCOS Without Cysts
Doctors don’t rely solely on ultrasound to diagnose PCOS. They also look at your symptoms, menstrual history, and hormone levels through blood tests. These tests often check for elevated testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, and thyroid function. If you have signs like irregular periods and high androgen levels, you may be diagnosed with PCOS even if your ultrasound is normal.
It’s important to understand that ultrasound results can be unreliable, especially for young women or those using hormonal birth control. In many cases, the ovaries may appear normal even when other symptoms are clearly present.
Why This Matters: Raising Awareness About Non-Cystic PCOS
Lack of visible cysts can often delay diagnosis or cause some doctors to dismiss PCOS as a possibility. This leads to frustration and untreated symptoms for many women. The emotional toll of not having answers while dealing with acne, facial hair, fatigue, or infertility can be significant. That’s why it’s crucial to raise awareness about the fact that cysts are not a requirement for PCOS. More inclusive and accurate understanding of the condition helps women get diagnosed earlier and receive proper care.
Some experts even argue that PCOS should be renamed to better reflect the hormonal nature of the condition. After all, the current name doesn’t capture the full picture of what women with PCOS are experiencing.
Final Thoughts: Don’t Wait for Cysts to Take Your Symptoms Seriously
If you’re struggling with hormonal issues like irregular periods, unwanted hair growth, or unexplained weight gain, don’t wait for ovarian cysts to appear on an ultrasound before seeking help. PCOS is more than just an ovary issue it’s a metabolic and hormonal condition that can impact many aspects of your health.
Learning more about your body, tracking your symptoms, and advocating for proper testing can make all the difference. You don’t need cysts to take PCOS seriously.
Msc. Human nutrition and Dietetics. Help women in losing weight with PCOS