Polycystic ovary syndrome ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]


The Rotterdam 2003 criteria include the use of ultrasound as a diagnostic tool in diagnosing polycystic ovary syndrome (PCOS). The typical polycystic-appearing ovary may emerge in a nonspecific fashion on an ultrasound. Multiple (12+) subcapsular follicles ranging from 2 to 9 mm in diameter in a state of arrested development ('pearl necklace' appearance) in a single ovary is diagnostic for PCOS on ultrasound.


Typical ultrasonography findings in patients with PCOS are as follows:[1][2][3]

  • Two- to 5-fold ovarian enlargement; ovarian volume >10 cm3
  • Thickened stroma (tunica albuginea)
  • Thecal hyperplasia with an increase in stromal content
  • Multiple (12+) subcapsular follicles ranging from 2 to 9 mm in diameter in a state of arrested development ('pearl necklace' appearance).
  • A discrete androgen-producing tumor in the ovary may be present in 5% or fewer patients.
  • The endometrium may be hyperplastic despite low estrogen production by the follicles; this is probably due to high estrone production from the increased circulating androgens and lack of opposition by progesterone.
  • Clomiphene may alter results due to ovarian stimulation, resulting in multiple ovarian cysts.


  1. Kenigsberg LE, Agarwal C, Sin S, Shifteh K, Isasi CR, Crespi R, Ivanova J, Coupey SM, Heptulla RA, Arens R (2015). "Clinical utility of magnetic resonance imaging and ultrasonography for diagnosis of polycystic ovary syndrome in adolescent girls". Fertil. Steril. 104 (5): 1302–9.e1–4. doi:10.1016/j.fertnstert.2015.08.002. PMC 4630153. PMID 26354095.
  2. Bachanek M, Abdalla N, Cendrowski K, Sawicki W (2015). "Value of ultrasonography in the diagnosis of polycystic ovary syndrome - literature review". J Ultrason. 15 (63): 410–22. doi:10.15557/JoU.2015.0038. PMC 4710692. PMID 26807298.
  3. Lujan ME, Jarrett BY, Brooks ED, Reines JK, Peppin AK, Muhn N, Haider E, Pierson RA, Chizen DR (2013). "Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume". Hum. Reprod. 28 (5): 1361–8. doi:10.1093/humrep/det062. PMID 23503943.

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