PCOS Without the Cysts: What Every Woman Should Know
Let’s clear something up:
You don’t need ovarian cysts to have PCOS.
That might sound confusing—after all, the name “Polycystic Ovary Syndrome” implies that cysts are the main issue. But in reality, PCOS is a hormone disorder, not just a cyst problem.
And because of that misunderstanding, thousands of women are misdiagnosed, dismissed, or completely overlooked—despite having all the classic signs of hormone dysfunction.
So What Is PCOS, Really?
PCOS is a condition driven by:
Androgen excess (too much testosterone or DHEA)
Insulin resistance (trouble handling blood sugar)
Ovulation dysfunction (irregular or absent cycles)
Yes, many women have small ovarian follicles that show up on ultrasound.
But that’s just one piece of the puzzle. You can have perfectly “normal” ovaries and still meet the criteria for PCOS.
Common Signs of PCOS (With or Without Cysts)
1. Irregular periods or no periods at all
This is a sign that ovulation isn’t happening consistently—one of the key PCOS markers.
2. Acne, especially along the jawline or chin
Driven by high androgens like testosterone and DHEA.
3. Unwanted hair growth (face, chest, abdomen)
Known as hirsutism—it’s a direct symptom of androgen excess.
4. Hair thinning on the scalp
Ironically, the same hormones that cause facial hair growth can cause scalp hair loss.
5. Weight gain, especially around the midsection
PCOS is often linked to insulin resistance, which pushes fat storage around the belly.
6. Fatigue, mood swings, or difficulty losing weight despite “doing everything right”
These are real symptoms—not just “life.”
But My Ultrasound Was Normal…
That doesn’t rule out PCOS.
In fact, the Rotterdam Criteria—one of the most widely accepted diagnostic guidelines—states that you only need two of the following three:
Irregular or absent ovulation
Elevated androgens (symptoms or labs)
Polycystic ovaries on ultrasound
So yes—you can absolutely have PCOS without cysts.
What Labs to Ask For
If you suspect PCOS, don’t stop at a basic hormone panel. Here’s what I recommend:
• Free & Total Testosterone
• DHEA-S
• LH:FSH ratio
• Fasting insulin & glucose
• HbA1c
• Cortisol (AM or 4-point if available)
• Progesterone (around day 21 if cycling)
And if you’re being dismissed with “everything looks normal,” it’s time for a second opinion.
PCOS Is Manageable—If You Treat the Root
Birth control may mask symptoms, but it doesn’t fix the underlying issue.
In my practice, we focus on:
• Restoring ovulation
• Supporting insulin sensitivity
• Reducing androgen excess
• Balancing cortisol and inflammation
• Nutrient repletion (especially inositol, zinc, magnesium, and B-vitamins)
Every case is unique—but PCOS isn’t a life sentence.
It just requires a deeper look and a real plan.
Struggling with symptoms that don’t add up? Let’s find out what’s going on.
Whether it’s PCOS or something else, I help women uncover what’s driving their hormone symptoms—and build a personalized roadmap to fix it.
Book a virtual consult at drnatefulton.com
