10/11/2026
Ever been told you don’t have PCOS because nothing showed up on your ultrasound?
Yep.
This is one of two stories I hear over and over. Years of irregular cycles. Cystic acne. Unwanted hair on the face, chest, or belly, while the hair on your head thins. Weight that won’t budge despite doing “all the right things.” Then an ultrasound, no cysts, and the conversation ends there.
The other story is the exact opposite: a history of ovarian cysts that keep getting treated as just cysts, with no one asking why they keep happening. (Not every ovarian cyst points to PMOS, since some are a normal part of ovulation. But recurring cysts plus the symptoms above deserve a deeper look.)
Here’s what the diagnostic criteria actually say.
The most widely used framework, the Rotterdam criteria, diagnoses PCOS/PMOS when you have two of these three, after ruling out other conditions that can look similar:
High androgens, either in symptoms like acne and unwanted hair growth, or in blood work
Irregular cycles or irregular ovulation
The “string of follicles” appearance on ultrasound
Two of three.
If you have irregular cycles and high androgens, you meet the criteria whether or not anything ever showed up on an ultrasound. Your ovaries do not have to “look like PCOS” for you to have it.
And even for the women who HAVE been diagnosed, the explanation is often one sentence. “You have PCOS because you’re insulin resistant.” Period.
The criteria are the starting point. Understanding why YOUR hormones are behaving this way is the real work.
If you’re reading this thinking that’s me, I offer a free 15-minute video consultation to talk through what you’ve been experiencing and whether functional medicine is the right fit. You can book through the link in my bio, comment for a deep dive on PMOS from my blog!
Serving women in Salina, KS, with telehealth in Kansas, Nebraska, Illinois, and Colorado.