Many people mistakenly think PCOS means “cysts in the ovaries”
When an ultrasound shows “multiple small follicles,” they start worrying about whether surgery is needed.

The truth is
PCOS is a hormonal disorder
not a large fluid-filled cyst that requires surgery.

This article clearly explains how PCOS differs from ovarian cysts, 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 male hormone levels

• Ultrasound showing multiple small follicles arranged around the ovary

The international diagnostic criteria, based on the American College of Obstetricians and Gynecologists, state that at least 2 of the 3 criteria must be met to diagnose PCOS.

What is an ovarian cyst?

An ovarian cyst is a fluid-filled sac that develops in the ovary
Most are simple cysts that occur with the menstrual cycle and go away on their own.

Some types can become large, causing lower abdominal pain, or in some cases may require surgery.

6 differences between PCOS and ovarian cysts

1️⃣ Cause

• PCOS is caused by hormonal imbalance

• Ovarian cysts develop from an abnormal fluid-filled sac in the ovary

2️⃣ Number and appearance of cysts

• PCOS shows multiple small follicles arranged around the ovary

• Simple cysts are usually one large fluid-filled sac, or a few cysts

3️⃣ Associated symptoms

• PCOS often causes irregular periods, acne, excess hair growth, and easy weight gain

• Ovarian cysts often cause lower abdominal pain, or no symptoms at all

4️⃣ Need for surgery

• PCOS does not require surgery

• Some ovarian cysts, if large or complicated, may require surgery depending on the type and size of the cyst

5️⃣ Effect on pregnancy

• PCOS may cause infertility because ovulation does not occur regularly

• Most ovarian cysts do not affect pregnancy, except for certain types

6️⃣ Treatment approach

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

• Ovarian cysts are usually monitored, or surgically removed in some cases

Is PCOS more dangerous?

PCOS is not an acute emergency
However, if left unmanaged, it may increase the risk of diabetes, high cholesterol, and abnormal thickening of the uterine lining.

Some ovarian cysts can cause sudden pain or ovarian torsion, but this is uncommon.

So if an ultrasound says “multiple follicles,” should you panic?

There is no need to panic right away
A doctor will assess your symptoms and hormone blood tests before making a diagnosis.

In many cases, the small follicles seen on ultrasound do not mean surgery is needed.

Short summary

PCOS is a hormonal disorder
Ovarian cysts are fluid-filled sacs that develop in the ovary.

They are not the same
and their treatment approaches are clearly different.

If you have irregular periods, lower abdominal pain, or concerns about your ultrasound results, consulting a specialist can help you better understand your condition.

Author

Dr. Wichadet Wichchulda
Obstetrics and Gynecology specialist
Currently pursuing subspecialty training in Maternal-Fetal Medicine at King Chulalongkorn Memorial Hospital

Research published in 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.