What does a doctor see on an ultrasound?
Each ovary always has a supply of small antral follicles, of which one dominant one matures in the cycle. Their number changes with age: young women have more follicles, after 35 years there are fewer of them. If there are many small follicles of the same size in the ovary, the doctor describes the picture as multifollicular. This is a description, not a conclusion about the disease. It is important on what day of the cycle the ultrasound was done, what access was used, and whether the picture coincides with the complaints and the nature of the menstrual cycle.
- Everyone normally has antral follicles.
- Their number is higher at a young age
- The picture depends on the day of the cycle and the device
- Ultrasound description does not equal diagnosis
- Assessed together with cycle and hormones
When is this the norm?
The multifollicular pattern is often found in teenage girls in the first years after the onset of menstruation, when hormonal regulation is still being adjusted. It occurs in women taking combined contraceptives because follicle maturation is suppressed. A similar picture is possible at the beginning of the cycle, with good ovarian reserve and in thin women. If menstruation comes regularly, ovulation occurs, there is no excess hair growth and problems with conception, such a finding does not require either treatment or repeated examinations in a circle.
- Adolescence and the formation of the cycle
- Taking hormonal contraceptives
- Beginning of cycle with ultrasound
- Good ovarian reserve
- Regular menstruation and no complaints
How is it different from polycystic disease?
Polycystic ovary syndrome is a diagnosis that is made when at least two of three signs are present: rare or absent ovulation, clinical or laboratory manifestations of excess male hormones, and a characteristic picture of the ovaries on ultrasound. That is, one ultrasound picture is not enough. With polycystic disease, the ovaries are usually enlarged in volume, the follicles are located on the periphery, and most importantly, there are cycle disorders, problems with conception, excess hair growth, acne, often excess weight and carbohydrate metabolism disorders. It is these signs, and not the word from the conclusion, that determine tactics.
- PCOS requires at least two out of three criteria
- Cycle disruption and lack of ovulation
- Excess male hormones and its manifestations
- Increased ovarian volume
- Often overweight and insulin resistance
- An ultrasound image alone does not provide a diagnosis.
What examination is needed
If the menstrual cycle is regular, there are no complaints and pregnancy occurs, additional examination is usually not required. In case of delays, problems with conception, excessive hair growth or acne, the doctor prescribes a hormonal examination: FSH, LH, testosterone, prolactin, TSH, AMH, as well as an assessment of carbohydrate metabolism. It is better to do an ultrasound on days 3–5 of the cycle. It is important to exclude other causes of cycle disruption - thyroid disease, increased prolactin, significant deficiency or excess body weight, excessive physical activity.
- Ultrasound of the uterus and ovaries on days 3–5 of the cycle
- FSH, LH, testosterone, prolactin
- TSH for thyroid assessment
- AMH as an indicator of ovarian reserve
- Assessment of glucose and insulin in overweight
- Maintaining a menstrual calendar
What to do next
If everything is in order, there is no need to treat the ultrasound picture: drugs and hormones are not prescribed to normalize the appearance of the ovaries. With confirmed polycystic ovary syndrome, the basis of treatment is lifestyle and weight loss if it is excess - even slight weight loss often restores ovulation. Further tactics are determined by the goal: regulating the cycle, reducing the manifestations of excess male hormones or planning pregnancy, and the doctor selects his treatment for each task. Self-administration of hormonal medications and dietary supplements is unacceptable.
- If there are no complaints, no treatment is required
- Losing weight if you are overweight
- Regular physical activity
- Treatment is tailored to a specific goal
- Observation by a gynecologist and endocrinologist
- Do not take hormones or supplements on your own
