PCOD ovarian cysts explained: are the dots on my scan harmful?

Many women first hear about PCOD from a scan report that says "polycystic ovaries" or "multiple small follicles". The word cyst sounds like something that has to come out. In PCOD, it almost never does.

What the dots on the scan are

Each ovary holds eggs inside tiny fluid-filled sacs called follicles. Each month one follicle usually grows, matures and releases an egg. In PCOD, many follicles start to grow and then stall. The egg inside is not released on time, and the sac stays small.

A scan sees these stalled follicles as many small dots, often arranged around the edge of the ovary. Some people describe the look as a string of pearls.

Why they are not harmful cysts

These sacs are follicles that have paused. They tell your doctor how the ovary is behaving. They are not growths.

Three points are worth holding onto. They are not harmful cysts. They do not turn into cancer. They usually do not need surgery. There is nothing to drain, burst or cut away.

What the dots do tell your doctor

The scan is one of three signs doctors look for. The Rotterdam criteria ask for any two of these three, after other conditions are ruled out:

• irregular periods or no ovulation
• high androgens, seen as signs on the body or in a blood test
• polycystic ovaries on a scan

So the scan helps, but it does not decide on its own. You can have dots on a scan and no PCOD. Small follicles seen on a scan with regular periods, easy conception and no symptoms is called PCOM. You can also have PCOD with an ordinary-looking scan, if the other two signs are present.

In teenagers, a scan alone is not used to diagnose PCOD in the first eight years after periods start. A young ovary is still settling in, and the picture needs the rest of the story.

What treatment aims at

Treatment is not aimed at the dots. It goes after what the dots reflect, which is irregular ovulation, high insulin and high androgens.

Lifestyle is the base. That means food, movement and sleep. If you carry extra weight, losing 5 to 10% of your body weight can bring back regular ovulation and periods. Medicines are chosen for your goal, whether that is regular periods, clearer skin, less hair or a baby.

If a baby is the goal and earlier steps have not worked, your doctor may talk about ovulation medicines, IUI or IVF. There is also LOD, a small keyhole surgery on the ovaries. It is used rarely, when other steps fail, and it is meant to help ovulation. It is not done to remove cysts.

Other cysts are a separate question

Ovaries can also develop cysts that have nothing to do with PCOD. A single larger cyst, or a cyst that comes with pain, is looked at on its own, by its size and how it appears on the scan.

If your report mentions a cyst beyond the usual small dots, ask your doctor to explain which is which. Do not assume it is the PCOD pattern, and do not assume it is dangerous either.

Sudden, severe pain low in the tummy is not something to wait out at home. It needs a doctor the same day.

What to bring to your appointment

Take your scan report and, if you can, the images. Bring a note of your period dates for the last few months, because the dates matter as much as the scan. Your doctor will usually add blood tests, since thyroid and prolactin problems can look like PCOD.

PCOD, PCOS and now PMOS, the new official name for PCOS, are all judged this way. The dots are one clue. The full picture decides.

A few questions are worth asking when you go over the report:

• Is this the usual PCOD pattern, or is there anything else on the scan?
• Which other tests do I need before anything is decided?
• What are my goals for the next 3 months?
• Does any of this change if I want a baby soon?

This article is education, not a diagnosis. A doctor who has seen your history, tests and scan decides what they mean for you.