Many people misunderstand that PCOS is an "ovarian cyst."
When an ultrasound reveals "multiple follicles," they often worry about whether surgery is necessary.

The truth is:
PCOS is a hormonal imbalance
and is not a large cyst that requires surgery.

This article will clearly explain how PCOS differs from an ovarian cyst, whether it is dangerous, and how it should be managed.

What is PCOS?

PCOS (Polycystic Ovary Syndrome) is a hormonal imbalance that causes irregular ovulation.

Key features of PCOS include:

• Irregular periods

• Elevated levels of male hormones (androgens)

• An ultrasound showing multiple small follicles arranged around the ovaries

According to the international diagnostic criteria referenced by the American College of Obstetricians and Gynecologists, a patient must meet at least 2 out of these 3 criteria to be diagnosed with PCOS.

What is an Ovarian Cyst?

An ovarian cyst is a fluid-filled sac that develops on or inside an ovary.
Most are simple cysts that form naturally during the menstrual cycle and resolve on their own.

Some types of cysts may grow larger, causing lower abdominal pain, and in some cases, surgical removal may be necessary.

6 Key Differences Between PCOS and Ovarian Cysts

1️⃣ Cause

• PCOS is caused by a hormonal imbalance.

• Ovarian cysts are fluid-filled sacs that develop abnormally on or inside the ovaries.

2️⃣ Number and Characteristics of Cysts

• In PCOS, multiple small follicles can be seen arranged around the ovary.

• A typical ovarian cyst is usually a single large sac or a few separate sacs.

3️⃣ Associated Symptoms

• PCOS often presents with irregular periods, acne, excess hair growth, and easy weight gain.

• Ovarian cysts often cause lower abdominal pain or may present with no symptoms at all.

4️⃣ Need for Surgery

• PCOS does not require surgery.

• Certain types of ovarian cysts, especially if they are large or cause complications, may require surgical removal depending on their type and size.

5️⃣ Impact on Pregnancy

• PCOS can lead to infertility due to lack of ovulation.

• Most ovarian cysts do not affect pregnancy, with the exception of certain types.

6️⃣ Treatment Approach

• PCOS management focuses on balancing hormones, weight management, and ovulation induction (if pregnancy is desired).

• Most ovarian cysts are managed with close monitoring or, in some cases, surgical removal.

Is PCOS More Dangerous?

PCOS is not an acute medical emergency.
However, if left unmanaged, it can increase the long-term risk of type 2 diabetes, high cholesterol, and endometrial hyperplasia (thickening of the uterine lining).

Certain types of ovarian cysts can cause acute, severe pain or ovarian torsion, though this is uncommon.

Should You Worry If an Ultrasound Shows "Multiple Follicles"?

There is no need to panic.
Your doctor will evaluate these findings alongside your symptoms and hormone blood tests before making a diagnosis.

In many cases, seeing small follicles on an ultrasound does not mean you need surgery.

Quick Summary

PCOS is a hormonal imbalance.
An ovarian cyst is a fluid-filled sac that forms on or inside the ovary.

These two conditions are distinct,
and their treatment plans are completely different.

If you are experiencing irregular periods, lower abdominal pain, or have concerns about an ultrasound result, consulting a specialist can help you properly understand your health.

About the Author

Dr. Witchadet Witchulada
Specialist in Obstetrics and Gynecology, Subspecialty in Maternal-Fetal Medicine, King Chulalongkorn Memorial Hospital

Published research in the International Journal of Transgender Health

References

1. American College of Obstetricians and Gynecologists. Practice Bulletin: Polycystic Ovary Syndrome.

2. World Health Organization. Reproductive health guidelines.

3. Williams Gynecology, 4th Edition.