Polycystic Ovaries – Everything you need to know

A term, that even though we’d like to change it–will probably stick forever!

It has that word “cyst” in it, so it sounds kind of scary–especially with the word ‘ovary’ right next to the word “cyst”.

OK–I’m up for nice feedback–I get to decide what gets posted as a comment–so if you are not clear after all this, pop a comment , and I will try to make clearer.

So, once you start your periods, you will start making cysts on your ovary ALL THE TIME!!  I know, I know—you never heard that before.  It’s true–it is the JOB of the ovary to make cysts every month.  That is how babies are made, and the human race goes on!

A review of your menstrual cycle.

When you start a period, your ovary gets all ready to start another cycle.  Your ovary has THOUSANDS of eggs–and several hundred start increasing in size at the start of a period.  Probably about 40-60 will be big enough to see on an ultrasound–and ONE (unless you are destined for twins or triplets), will go on to OVULATE.

Click on picture to see it larger.


These many cysts are called FOLLICULAR CYSTS.  They make your ovary look lumpy on the surface, like a walnut.  Your ovary is about the size of a walnut.

This is a picture of a normal pelvis.  All those little bluish things you see on the white ovary are normal tiny follicular cysts.


Now at “mid cycle”, you OVULATE–and the main/dominant follicle bursts, to release an egg into your fallopian tube.

This site has some cool info on ovulation cysts!

These videos also helps explain what happens during your cycle.




NOW—‘poly’ means ‘too much or too many’, and ‘cystic’ means “has a cyst”–so ‘polycystic’ is used when you have a bunch of follicular cysts, but a dominant one does not get released on a regular basis.

YOU STILL NEED TO USE SOME PROTECTION AGAINST PREGNANCY–that ovary is unpredictable–and CAN release an egg just when you don’t expect it to–so DON’T go around thinking you CAN’T get pregnant—you are just less likely to!

So a normal ultrasound of an ovary around time of ovulation will show a DOMINANT follicle.  See it?


With polycystic ovary, you get what we call a PEARL NECKLACE effect when you look on ultrasound


There is no DOMINANT follicle–just a bunch of little ones–most under 1/2 cm.  These follicles make your ovary look bigger on ultrasound, AND when you look inside with a scope!


Those round white things are your ovaries–and this is what they can look like if you do not ovulate due to polycystic ovary syndrome.

Not EVERY woman with PCOS has enlarged ovaries—and some ovaries LOOK like they have PCOS, but the woman has completely normal cycles.


We don’t know WHY some women get this, and others don’t.   There is a much higher risk if you are overweight–but I have seen it in thin women too!  There is some imbalance in the way things work—from your brain– right to the ovary.  About 70% of women with this condition are obese–and THAT brings up other things you have to look for when you come into your doctor, and get diagnosed with this.   Read on!

Do you watch SPONGEBOB??  There is a little gland in the base of your brain that acts like PLANKTON—it wants to control the universe–and really DOES control pretty well everything in your body.  It is the size of a PEA!–and look what it controls!!


To fine tune the effect of the pituitary on the ovary, we need hormones that make the eggs in the ovary grow, and another hormone to make the dominant egg (follicle) burst, and release the egg into your tubes.  When this gets screwed up, you get a bunch of ‘wannabes’, but no one egg that goes all the way to ovulation!

Not only that—the ovary makes both MALE and FEMALE hormones, and if you imagine the ovary like a chicken egg, then the egg white is what makes the female hormones, and produces the eggs, and the YOLK is what makes the MALE hormones.  The male hormones are overproduced with PCOS–and you tend to get that hair growing where you don’t want it–upper lip, side burns, chin, around your nipples, and up your belly!  Some women are really sensitive to that male hormone, and end up shaving every day!  This hairiness is known as HIRSUTISM  (Her-suit-issum).


Really, unless you are literally having issues with an enlarging clitoris, and voice changes, there is no point measuring male hormone levels–they will be up.  There is really no point measuring your estrogen and progesterone and FSH (follicle stimulating hormone from that pituitary) or LH, if you have ever had a period.

The only tests that really help make the diagnosis are the THYROID TEST, and a PROLACTIN (ANOTHER pituitary gland hormone issue).

If you have a NORMAL thyroid, and prolactin test, then we just need to see if you bleed after taking 10 days of progesterone.  Your uterus is getting all kinds of estrogen—building up that lining–waiting and waiting for an egg–that rarely comes.

In a NORMAL cycle, when ovulation occurs, the ovary starts producing another hormone called progesterone.  This progesterone is produced by the dominant follicle after rupture–and it is meant to get that lining of the uterus all set for a fertilized egg.  If the egg is not fertilized, it is reabsorbed by the body, and the progesterone in your blood drops off–you then have a period.  Stopping the progesterone medication in 10 days leads to a drop in the progesterone in your blood, and you should have a period.   If you don’t, then we have to regroup, and rethink–SOME women require a different form of progesterone, AND you may need to get more hormone levels checked.

Now, if you have not had a period in a few months–your first one may be a humdinger–brace yourself!

If you bleed, the diagnosis is made.

This link is a wonderful explanation of PCOS


Maybe 70%, or more, of women with PCOS have something called INSULIN RESISTANCE.

Your pancreas produces insulin, and the job of insulin is to move sugar out of your blood stream into your cells.  Think of insulin as a key that fits into a lock on the door of a cell, and unlocks the door to let sugar into the cell.  With insulin resistance, the lock is not letting the insulin key fit as well.  This means the sugar cannot get in!  The cells require sugar–so even though there is plenty of sugar in the blood stream, your pancreas keeps making more insulin–kind of hoping that if it produces more then it can act as a battering ram, and ram its way into the cell lock, to let the sugar in.  You can look at it as some of the locks are defective, and won’t let the insulin, or sugar into the cell.


Now if you have more sugar in your blood stream–what do you think happens next?


When you are obese, and have insulin resistance, you are at risk for something called METABOLIC SYNDROME.

What the heck is that now?   Oh—-just one of the biggest causes of heart attack and stroke s’all.

ASK YOUR DOCTOR if you have metabolic syndrome.  There are 5 criteria–you need THREE out of the five.

The criteria are:

  1. waist over 35 inches (89cm) in a woman
  2. blood pressure over 130 on top OR over 85 on bottom(or on blood pressure meds)
  3. triglycerides over 150 mg/dl (1.7mmol/L)
  4. HDL (good cholesterol) under 50 mg/dl in a woman (1.2 mmol/L)
  5. fasting sugar over 100 mg /dl (5.6 mmol/L)-or on meds for sugar issues.

You need THREE!

Why worry?

This it what it can lead to!



The other thing it doesn’t mention in this chart is depression, alcohol and drug use, poor self-image—it is like a snowball rolling down a mountain!

Anyway–back to your irregular periods—what to do?

Basically, I divide women with PCOS into groups:

  1. not sexually active–no need for contraception
  2. sexually active–not ready for children, so needs contraception
  3. sexually active–wants to get pregnant

If you are not sexually active, you may be enjoying the lack of periods.    NOT GOOD!!!!   DO NOT GO MORE THAN 60 days without a period!!  That lining just builds up and builds up–so then you can have heavy irregular bleeding, PLUS that lining can turn into the BIG C, if this goes on for a few years.  I have seen endometrial cancer in women in mid 30s!!!

If you are in group 2, birth control pills are really quite wonderful.  They prevent pregnancy, regulate periods, AND help reduce hairiness, and male hormone effect.

Mirena IUD is a nice option too!

You can look at birth control options in the post on birth control.

If you are in group 3, then it gets a little more complicated.  I am going to do a post on basic infertility but, for now, you need three things, basically, to get pregnant:

1 an egg–so you need to ovulate

2.  good sperm (yes–he has to get his stuff checked out in lab)

3.  open fallopian tubes

On top of the no egg problem, we have the insultin resistance.

There are meds we use to try and force your ovary to ovulate–the main one being Clomiphene or Serophene.

The other drug you may be prescribed, if you meet criteria for metabolic syndrome, or presumed insulin resistance, is METFORMIN.

That’s all folks!   Those links really explain the drugs.




1 Reply to “Polycystic Ovaries – Everything you need to know”

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