Bilateral Polycystic Ovaries: What It Means & Its PCOS Link

Any mention of ovarian cysts probably makes you think of PCOS, which is the acronym for Polycystic Ovary Syndrome. This is understandable because there has been a lot of talk about PCOS in India in recent years, with experts warning about its rising incidence and public figures speaking out about their experiences of PCOS. Although the condition is strongly associated with the presence of ovarian cysts or polycystic ovaries, simply having polycystic ovaries does not mean that you have PCOS, as it is a multi-faceted condition, involving a variety of hormonal, metabolic, and reproductive disturbances. This begs the question, “What are bilateral polycystic ovaries, and should you be concerned?”

What are bilateral polycystic ovaries?

As the word bilateral suggests, bilateral polycystic ovaries affect both left and right ovaries. The condition itself refers to the presence of multiple small cysts on the ovaries. These cysts form as a result of hormonal imbalances, and they are actually immature follicles that fail to develop and release an egg during the ovulation process. This is a common feature seen in PCOS, which is why it may be confused, but not every woman with bilateral polycystic ovaries has PCOS. The condition may develop due to a variety of other factors, such as certain thyroid disorders or adrenal conditions.

If your screening tests have revealed the presence of bilateral polycystic ovaries, it’s critical that you talk to your doctor as soon as possible to get an accurate diagnosis. Your doctor will review your medical history, symptoms, and probably recommend additional tests to confirm or rule out a diagnosis of PCOS. Treatment can then be provided promptly to delay disease progression and lower the risk of possible complications.

Difference between bilateral polycystic ovaries and PCOS

While the terms bilateral polycystic ovaries and PCOS  are often used interchangeably, they are not the same, and understanding the distinction is important for diagnosis and treatment.

PCOS is a complex endocrine (hormonal) disorder that affects women of reproductive age. It involves a combination of symptoms and hormonal imbalances, including elevated levels of androgens (commonly referred to as ‘male’ hormones), irregular or absent periods, acne, weight gain, difficulty ovulating, and sometimes infertility. One of the possible features of PCOS is the presence of multiple small cysts on the ovaries.

On the other hand, bilateral polycystic ovaries refer to the presence of multiple small cysts in both ovaries. This can occur in women with PCOS, but it may also appear in those who do not have any other signs or symptoms of the condition. In some cases, these cysts are discovered incidentally during routine scans and may not cause any health concerns or hormonal issues.

To put it simply:

• PCOS is a broader syndrome that includes a combination of hormonal imbalances, metabolic issues, and possible ovarian changes.

• Bilateral polycystic ovaries are a structural or anatomical description, referring only to the appearance of the ovaries, not a diagnosis on their own.

What causes bilateral polycystic ovaries?

Bilateral polycystic ovaries can be caused by a variety of factors, with most of these bearing a strong association with PCOS. Some of these include: 

Normally, each month the ovary recruits a few immature follicles, and with proper coordination of hormones from the pituitary and hypothalamus, one (sometimes two) mature eggs are released. 

This process requires a delicate hormonal balance. When this balance is disrupted, the ovary accumulates multiple immature follicles at different stages of development, without releasing a mature egg. Since the ovaries are responsible for hormone production, egg release, and secretion of inhibin, all these functions are affected. The outcome is polycystic ovary syndrome (PCOS), which presents with a wide spectrum of symptoms depending on its severity.

• Hormonal imbalances that raise levels of male hormones like testosterone and increased insulin resistance inhibit normal ovulation. As maturation of eggs is impaired, they begin to accumulate as tiny follicles or cysts in the ovaries.

• Genetic factors, obesity, and a sedentary lifestyle can also increase the risk of hormonal dysregulation, which can give rise to both bilateral polycystic ovaries and PCOS.

• In some cases, bilateral ovarian cysts may develop during adolescent anovulation or with ovarian hyperstimulation, as is seen in some fertility treatments. It could also occur as a result of endocrine disorders such as hypothyroidism or hyperprolactinemia.

Symptoms of bilateral PCOS (When linked with PCOS)

Bilateral polycystic ovaries develop as just one feature of the condition, so when linked with PCOS, you can experience a variety of symptoms. These bilateral PCOS symptoms include:

• Irregular or absent menstrual periods (oligo-amenorrhea)

• Unchecked hormonal cycles can cause excessive thickening of the endometrial lining, leading to very heavy periods

• Hirsutism or excessive hair growth, male-pattern hair thinning, and acne, resulting from high levels of androgens

• Insulin resistance and high blood sugar

• Problems with fertility and getting pregnant

• Weight gain and difficulty losing weight

If the development of cysts is not linked to PCOS, it is more likely to be asymptomatic or may cause other symptoms like discomfort in the pelvic region.

Diagnosis: How do you know if it’s PCOS?

There’s no way to confirm or rule out PCOS without further testing, as ovarian cysts are not the only feature of PCOS, and may be linked to other conditions. If you have bilateral ovarian cysts, doctors will use other diagnostic criteria, looking at your symptoms, as well as levels of specific hormones such as testosterone and thyroid hormones, to make a definitive diagnosis. Getting an accurate and swift diagnosis is critical to improve outcomes and lower the risk of long-term complications, as treatment recommendations will vary depending on the underlying cause of the ovarian cysts.

Frequently Asked Questions

1. Are bilateral polycystic ovaries the same as PCOS?

No, it is a common feature in PCOS, but not all cases of bilateral polycystic ovaries are caused by the condition and may also result from thyroid disorders or other conditions.

2. Can bilateral polycystic ovaries be treated?

Treatment options will vary, depending on the underlying cause. These can include a combination of lifestyle and dietary interventions, along with medications.

3. Will bilateral polycystic ovaries cause other complications?

If the underlying condition that caused bilateral polycystic ovaries remains untreated and poorly managed, there is a high risk of complications involving reproductive, metabolic, and cardiovascular health.