If you or someone close to you has been experiencing symptoms like irregular periods, difficulty conceiving, or unexpected changes in weight, you may have come across terms like PCO (Polycystic Ovaries) and PCOS (Polycystic Ovary Syndrome). While they may sound similar, PCO and PCOS are distinct conditions, each with its own effects on reproductive health and overall well-being. This can be understandably confusing, as both terms often appear together in discussions about hormone balance and fertility.
In this article, we’ll clarify the differences between PCO and PCOS, explore how each condition impacts the body, and discuss diagnostic options and treatments, including fertility treatment. If you have already received a referral for fertility, you may like to read our article Referred to gynaecologist for fertility.
Understanding these distinctions can be reassuring, offering clearer insight into what to expect and how best to manage symptoms. Whether you’re navigating these changes yourself or supporting a loved one, we’re here to provide clear, compassionate guidance that addresses your concerns and helps you make informed decisions about health, well-being and fertility. If fertility is a concern for you, you may also wish to read our article How do I know if I have infertility problems?
What are PCO and PCOS?
Definition of PCO (Polycystic Ovaries)
Polycystic Ovaries, often referred to as PCO, describe ovaries that contain a larger number of small, undeveloped follicles. These follicles are fluid-filled sacs that hold immature eggs and may appear in greater numbers than usual. Despite the term "cystic," these follicles aren’t true cysts but are harmless and often symptomless, generally not impacting overall health. PCO is primarily identified through an ultrasound and is common among women, with many experiencing no adverse effects on their reproductive health or hormone balance.
While the presence of polycystic ovaries might sound concerning, it’s essential to note that having PCO does not necessarily indicate a hormonal imbalance or other symptoms typically associated with PCOS. Many individuals with PCO continue to ovulate regularly and can conceive without difficulty.
Definition of PCOS (Polycystic Ovary Syndrome)
Polycystic Ovary Syndrome, or PCOS, is a hormonal disorder that can affect the ovaries, leading to a variety of symptoms that may impact reproductive health and overall wellbeing. Unlike PCO, PCOS is a syndrome, meaning it involves multiple symptoms and often includes a hormonal imbalance that can disrupt regular ovulation. Typical symptoms of PCOS include irregular periods, increased levels of androgens (male hormones) which can cause issues like excessive hair growth and acne, and, in some cases, difficulty with fertility.
PCOS can also be associated with other health conditions such as insulin resistance and, over time, may increase the risk of developing type 2 diabetes or cardiovascular issues. Because PCOS is more complex, it generally requires a more comprehensive approach to diagnosis and management.
Are PCO and PCOS the same?
Key differences in symptoms and diagnosis
Although PCO and PCOS may sound similar, they are distinct conditions with different impacts on the body. Polycystic Ovaries (PCO) typically refer to a physical characteristic of the ovaries, where multiple small follicles are visible on an ultrasound. Individuals with PCO usually don’t experience symptoms beyond this, and their hormone levels are generally within a normal range. Diagnosis of PCO is often incidental, meaning it is discovered during a routine scan or fertility assessment but doesn’t typically lead to further medical intervention.
Polycystic Ovary Syndrome (PCOS), however, is a more complex condition involving a broader range of symptoms and a hormonal imbalance. Along with the presence of multiple follicles in the ovaries, PCOS is associated with irregular menstrual cycles, signs of excess androgens such as increased facial or body hair, and sometimes difficulties with weight management. Diagnosing PCOS requires meeting specific criteria, usually involving two of the following: irregular or absent periods, high androgen levels, and polycystic ovaries. This combination of symptoms and hormone disruption makes PCOS a syndrome rather than simply a structural characteristic of the ovaries.
How PCO and PCOS affect hormone levels
Hormone levels are typically a defining factor in distinguishing between PCO and PCOS. In cases of PCO, hormone levels remain largely unaffected, meaning the ovaries may have a higher number of follicles without influencing the balance of hormones like oestrogen, progesterone, or androgens. Individuals with PCO often experience regular menstrual cycles and do not face the same hormonal challenges seen in PCOS.
PCOS, by contrast, is marked by a notable hormonal imbalance, especially an increase in androgens (male hormones) like testosterone. This rise in androgen levels can lead to a range of symptoms, such as acne, excess hair growth, and changes in skin texture. Additionally, PCOS may impact insulin levels, leading to insulin resistance, which can further disrupt hormone balance and make managing weight more challenging. This hormonal imbalance is a key factor in both the symptoms and the diagnostic criteria for PCOS, differentiating it significantly from PCO.
PCO vs PCOS: Diagnosing with ultrasound
What an ultrasound can reveal about PCO and PCOS
Ultrasound imaging is often a crucial tool in diagnosing both PCO and PCOS. For individuals with Polycystic Ovaries (PCO), an ultrasound will typically reveal an increased number of small follicles on the ovaries. These follicles, sometimes described as "pearl-like," are usually underdeveloped and do not indicate a problem by themselves. For someone with PCO, the ovaries might show more than the usual number of follicles but without other symptoms of hormonal imbalance.
In cases of Polycystic Ovary Syndrome (PCOS), ultrasound findings may also show multiple small follicles on the ovaries, but this alone is not sufficient for a PCOS diagnosis. PCOS is a syndrome and, therefore, requires the presence of other criteria such as irregular periods and elevated androgen levels, alongside these ultrasound results. Ultrasound imaging for PCOS may look similar to PCO; however, it is only one piece of a broader diagnostic puzzle and is typically paired with hormone tests and a thorough clinical assessment to confirm PCOS.
Bilateral PCO vs PCOS: What’s the distinction?
In ultrasound diagnostics, you may hear the term "bilateral PCO," which means that both ovaries show multiple small follicles characteristic of PCO. Bilateral PCO is a structural finding and is common among individuals with PCO, indicating that the follicles are present on both sides but without hormonal symptoms or irregularities associated with PCOS. People with bilateral PCO often have regular menstrual cycles and do not experience the broader hormonal effects seen in PCOS.
For those with PCOS, while both ovaries may also show similar multiple follicle patterns on an ultrasound, the distinguishing factor is that PCOS encompasses other symptoms beyond just the physical appearance of the ovaries. This distinction is essential: having bilateral PCO does not necessarily lead to PCOS, as PCOS involves a broader syndrome of hormonal imbalances and metabolic considerations, whereas bilateral PCO remains a structural observation without these additional impacts on health.
Impact on fertility- PCO vs PCOS
Can you get pregnant with PCO?
For individuals with Polycystic Ovaries (PCO), fertility is often unaffected, as PCO generally does not cause hormonal imbalances or interfere with ovulation. Studies show that most individuals with PCO ovulate regularly and can conceive without additional fertility treatments, as the presence of multiple ovarian follicles in PCO typically does not hinder the menstrual cycle [1]. However, some individuals with PCO may still experience unrelated fertility challenges depending on other health factors [2].
How PCOS Can Influence Fertility
PCOS, on the other hand, can present more challenges for those trying to conceive, primarily due to its impact on hormone levels and ovulation. The hormonal imbalances associated with PCOS, especially elevated androgen levels can disrupt menstrual regularity and result in irregular or absent ovulation, which significantly impacts fertility [3]. This irregular ovulation pattern often makes natural conception more difficult for individuals with PCOS [4].
Additionally, insulin resistance, commonly seen in PCOS, can further affect fertility by exacerbating hormonal imbalances and impairing ovulation. Evidence suggests that managing insulin resistance through lifestyle changes or medications can help improve ovulation patterns, thereby enhancing fertility outcomes for those with PCOS [5].
For those facing fertility challenges due to PCOS, effective treatments are available. Medications like Clomiphene and Letrozole are often prescribed to stimulate ovulation, and in more complex cases, assisted reproductive technologies such as in vitro fertilisation (IVF) may be considered [6]. With the right support, many individuals with PCOS can successfully conceive despite the condition’s associated fertility hurdles.
PCO without PCOS: What does it mean?
It’s not uncommon for individuals to have Polycystic Ovaries (PCO) without meeting the criteria for Polycystic Ovary Syndrome (PCOS). PCO simply refers to the appearance of multiple small follicles in the ovaries, often discovered incidentally during an ultrasound. Research indicates that a significant number of people, up to 20% of reproductive-age women, have polycystic ovaries without experiencing the hormonal imbalances, irregular cycles, or other symptoms associated with PCOS [7]. In these cases, PCO is a benign finding that generally doesn’t affect health or require medical intervention.
The distinction is essential, as having polycystic ovaries alone does not indicate a syndrome. Many with PCO continue to have regular menstrual cycles and typical hormone levels, experiencing no adverse symptoms related to the ovarian structure.
Effects on menstrual health and pregnancy
For those with PCO but without PCOS, menstrual health and pregnancy potential are generally unaffected. Since PCO does not typically disrupt hormone levels, most individuals maintain a regular ovulation cycle, making it possible to conceive naturally. Unlike PCOS, where hormonal imbalances can lead to irregular or absent periods, PCO alone does not usually interfere with the menstrual cycle or fertility [8].
In some cases, individuals with PCO may experience mild menstrual irregularities, but these are often manageable and do not signify underlying hormonal disruption. Importantly, PCO alone does not lead to the same metabolic or cardiovascular risks associated with PCOS. For those trying to conceive, PCO is generally not a barrier, and the likelihood of natural conception remains high without the need for additional medical intervention.
How to know if you have PCO or PCOS
Identifying whether you have PCO or PCOS can feel a bit like trying to piece together a puzzle. While PCO (Polycystic Ovaries) typically comes with few noticeable symptoms and might go unnoticed altogether, PCOS (Polycystic Ovary Syndrome) tends to show itself in more obvious ways. You might never even notice it’s there unless you have an ultrasound for another reason. PCO alone doesn’t usually disrupt your menstrual cycle or affect hormone balance, so many people with PCO go about life without ever knowing they have it.
PCOS, however, can feel more like an “uninvited visitor” that makes its presence known. Symptoms may include irregular or missed periods, increased facial or body hair, changes in weight, and sometimes even difficulty with fertility. These signs occur because PCOS brings along a hormonal imbalance that affects your body in more noticeable ways. If you’re experiencing any of these symptoms, it could be worth exploring further with a healthcare professional to determine whether PCOS might be the cause.
Consulting a specialist for accurate diagnosis
A specialist, such as a gynaecologist or endocrinologist, can provide insight, tools, and a clear path forward. Diagnosing PCO and PCOS usually involves an ultrasound to look at your ovaries, alongside blood tests to check hormone levels. Combining these tests provides a clearer picture and helps ensure an accurate diagnosis.
A specialist will also look at your medical history, current symptoms, and any other relevant factors to get a well-rounded view of your health. This comprehensive approach allows them to distinguish between PCO and PCOS, helping you understand what’s going on in your body. Remember, whether it's PCO or PCOS, knowing the exact cause allows for more informed choices about your health, and finding a healthcare “guide” can make the journey much more manageable.
Common concerns: weight gain, fertility, and more
Does PCO cause weight gain?
Polycystic Ovaries (PCO) alone generally does not cause weight gain, as it is primarily a structural characteristic of the ovaries rather than a condition that impacts hormone levels. Unlike Polycystic Ovary Syndrome (PCOS), which can involve insulin resistance and elevated androgen levels that contribute to weight fluctuations, PCO typically does not disrupt metabolic functions. Since individuals with PCO usually maintain a balanced hormone profile, they are less likely to experience the weight challenges associated with PCOS [9]. However, lifestyle factors and other health conditions can still influence weight, and individuals with PCO may have unique metabolic responses depending on their overall health [10].
Lifestyle adjustments to manage PCO and PCOS symptoms
For both PCO and PCOS, lifestyle adjustments can play an essential role in symptom management, though the focus may differ based on each condition. A strong foundation of health can support better hormonal health, while a shaky one might leave room for symptoms to arise or intensify.
For individuals with PCOS, managing weight and balancing insulin levels can be essential. Evidence suggests that adopting a diet rich in whole grains, lean proteins, healthy fats, and low-glycaemic foods may help reduce insulin resistance and improve hormone balance [11].
Regular physical activity, such as brisk walking, strength training, or yoga, has also been shown to help regulate blood sugar levels, supporting more stable hormone levels and reducing some of the symptoms associated with PCOS [12].
Those with PCO, while not necessarily impacted by hormonal imbalance, can also benefit from these lifestyle habits to maintain optimal health. A balanced diet and consistent exercise routine support general metabolic health, aiding in weight management and reducing the risk of any potential future complications. Furthermore, focusing on whole, nutrient-dense foods can provide sustained energy, promote hormonal stability, and support overall wellbeing [13].
Ultimately, while lifestyle changes can be beneficial, it’s also essential to work with healthcare professionals who can guide these efforts and tailor them to your individual health needs.
Why seek treatment and what will happen if PCO and PCOS are left untreated?
Seeking treatment for PCO and PCOS can make a substantial difference in managing potential symptoms and preventing longer-term health complications. Although Polycystic Ovaries (PCO) and Polycystic Ovary Syndrome (PCOS) differ significantly in terms of their impact, leaving either condition unmanaged may still have repercussions.
PCO
For individuals with PCO alone, where there is no associated hormonal imbalance or metabolic impact, the condition is generally benign and does not require specific treatment. Most individuals with PCO continue to have regular menstrual cycles, maintain normal hormone levels, and do not experience symptoms beyond the physical appearance of multiple ovarian follicles. If PCO is left untreated, in most cases, it does not lead to any significant health issues or complications, and regular monitoring is typically sufficient [14].
However, it’s always advisable to maintain a healthy lifestyle, as weight management and balanced nutrition support ovarian health and can help avoid other unrelated health issues.
Periodic check-ups can also be beneficial to ensure that the PCO has not developed into PCOS, which may require a more proactive management approach.
PCOS
PCOS, on the other hand, can have more serious implications if left untreated due to the hormonal and metabolic disruptions associated with the syndrome. Elevated androgen levels and insulin resistance are common in PCOS and can lead to long-term issues if not addressed. Untreated PCOS can increase the risk of several conditions, including:
Infertility: Since PCOS can cause irregular or absent ovulation, untreated PCOS may lead to challenges with conception. Treatment can often restore ovulatory cycles, increasing the chances of natural pregnancy [15].
Type 2 Diabetes: Insulin resistance in PCOS can progress to type 2 diabetes if left unchecked, as the body struggles to regulate blood sugar levels effectively over time [16].
Cardiovascular Risks: Higher androgen levels and insulin resistance can also contribute to heart health risks, including high cholesterol and hypertension, especially as individuals with PCOS age [17].
Endometrial Health: Irregular or absent menstrual cycles can increase the risk of endometrial hyperplasia and, in rare cases, endometrial cancer due to unopposed oestrogen exposure in the uterus [18].
Seeking early intervention and management for PCOS is crucial to minimise these risks:
Treatments like lifestyle changes, dietary adjustments, and medications can help manage insulin resistance, regulate menstrual cycles, and reduce androgens, providing a solid defence against future health complications.
Treatment options for PCO and PCOS
Managing PCO for better reproductive health
For individuals with Polycystic Ovaries (PCO), treatment is typically unnecessary unless there are specific reproductive goals or concerns. Since PCO usually does not involve hormonal imbalances or menstrual irregularities, most people with PCO can maintain reproductive health through a balanced lifestyle that includes regular exercise, a nutrient-rich diet, and healthy weight management. These factors help support overall ovarian health, ensuring a stable hormonal environment that promotes regular ovulation [19].
However, if someone with PCO is actively trying to conceive, consulting with a fertility specialist may be beneficial. Simple interventions such as ovulation tracking, healthy lifestyle adjustments, and periodic ultrasounds to monitor ovarian health can provide reassurance and support reproductive goals. Private healthcare providers often offer more immediate access to these resources, with dedicated time for personal consultations, giving individuals more tailored support for their fertility journeys.
Treatment approaches for PCOS symptoms and fertility
PCOS, due to its hormonal and metabolic effects, often requires a more structured approach to treatment. Managing PCOS can include lifestyle modifications, medication, and, in some cases, fertility treatments. Key components of PCOS treatment involve:
Lifestyle Modifications: Diet and exercise play a significant role in managing insulin resistance, stabilising hormone levels, and promoting weight management, which can alleviate symptoms and support ovulatory health [20].
Medications: For those needing further support, medications can be highly effective. Hormonal contraceptives are commonly used to regulate menstrual cycles and reduce androgen-related symptoms, while medications like Metformin help manage insulin levels, reducing the risk of type 2 diabetes [21].
Fertility Treatments: If pregnancy is the goal, medications such as Clomiphene and Letrozole may be prescribed to stimulate ovulation, improving the chances of conception. In some cases, assisted reproductive techniques like in vitro fertilisation (IVF) may also be recommended, especially if ovulation-stimulating medications alone are insufficient [22].
Private treatment options
Seeking private treatment for PCOS offers a range of benefits, particularly if you're looking for personalised, immediate care tailored to your specific needs. One of the biggest advantages of private care is reduced waiting times; instead of waiting weeks or months for an appointment, you’ll likely be able to see a specialist sooner, allowing for quicker diagnosis and more timely intervention.
In private healthcare, you’ll also have access to a team of specialists who bring together expertise in reproductive endocrinology, nutrition, and lifestyle management, all essential elements in managing PCOS. Your care will be fully integrated and customised, meaning your treatment plan will reflect your unique health profile and personal goals. For example, if you’re experiencing metabolic symptoms like insulin resistance alongside hormonal issues, your treatment plan can address both aspects holistically.
Private consultations are designed to be more thorough, giving you time to discuss all of your symptoms, concerns, and any specific objectives, like fertility. This patient-centred approach provides the opportunity to go in-depth with your healthcare provider, exploring questions, testing options, and strategies that might be overlooked in a more standardised setting.
Private clinics often have access to advanced diagnostic tools and cutting-edge treatments, which can make a real difference in accurately assessing your condition and developing an effective, responsive treatment plan. For those managing complex symptoms or actively trying to conceive, the proactive and supportive nature of private care provides an added layer of reassurance and support, empowering you to make informed decisions about your health journey.
Conclusion
Navigating the complexities of PCO and PCOS can feel overwhelming, but understanding the differences and knowing your treatment options are key steps towards taking control of your reproductive health. Whether you're managing PCO or PCOS, there are effective strategies and treatments available that can significantly improve your symptoms and support your long-term wellbeing.
For those looking to enhance their care with a personalised, attentive approach, The Rylon Clinic is here to help. At The Rylon Clinic, we offer advanced, patient-centred gynaecological care in the heart of London. With a commitment to providing comprehensive support, we combine cutting-edge diagnostics with compassionate expertise to help you understand and address your unique needs.
The clinic’s dedicated team understands the nuanced challenges of PCO and PCOS, offering tailored treatment plans designed to fit your lifestyle and health goals. With a streamlined and responsive private healthcare experience, The Rylon Clinic aims to make your journey as smooth as possible, ensuring you receive the attentive and professional care you deserve.
Whether you’re seeking to manage PCOS symptoms, explore fertility options, or simply get a clearer diagnosis, The Rylon Clinic is equipped to guide you every step of the way, helping you make informed, empowered choices for your health and future.
References
1. Vrbíková, J., & Cibula, D. (2005). "Polycystic Ovary Syndrome and Its Association with Hyperandrogenism and Metabolic Syndrome." Human Reproduction Update, 11(5), 435–447.
2. Dewailly, D., et al. (2011). "Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society." Human Reproduction Update, 17(2), 265–280.
3. Azziz, R., et al. (2004). "The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report." Fertility and Sterility, 91(2), 456–488.
4. Goodarzi, M. O., et al. (2011). "Polycystic Ovary Syndrome: Etiology, Pathogenesis and Diagnosis." Nature Reviews Endocrinology, 7(4), 219–231.
5. Legro, R. S., et al. (2007). "Insulin resistance in the polycystic ovary syndrome: Mechanism and implications for pathogenesis." Endocrine Reviews, 28(6), 785–800.
6. Palomba, S., et al. (2009). "Ovulation induction in women with polycystic ovary syndrome: treatment options." Best Practice & Research Clinical Obstetrics & Gynaecology, 23(5), 621–631.
7. Teede, H. J., et al. (2018). "Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome." Human Reproduction, 33(9), 1602-1618.
8. Dewailly, D., et al. (2011). "Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society." Human Reproduction Update, 17(2), 265–280.
9. Norman, R. J., et al. (2004). "Lifestyle modifications in the management of polycystic ovary syndrome." Human Reproduction Update, 10(5), 377-388.
10. Moran, L. J., et al. (2013). "The association between polycystic ovary syndrome and metabolic syndrome in reproductive-age women." Human Reproduction Update, 19(2), 221-238.
11. Galletly, C., et al. (2008). "Managing Insulin Resistance in Polycystic Ovary Syndrome." Diabetes Care, 31(5), 977-983.
12. Hutchison, S. K., et al. (2011). "Exercise Improves Insulin Resistance and Body Composition in Overweight and Obese Women with Polycystic Ovary Syndrome." The Journal of Clinical Endocrinology & Metabolism, 96(1), E107-E114.
13. Moran, L., et al. (2009). "Dietary composition in the treatment of polycystic ovary syndrome: A systematic review to inform evidence-based guidelines." Journal of the Academy of Nutrition and Dietetics, 109(4), 575-584.
14. Lujan, M. E., et al. (2010). "Prevalence of polycystic ovarian morphology without the syndrome in normal women with regular menstrual cycles." Fertility and Sterility, 94(2), 673-677.
15. Balen, A. H., et al. (2009). "Polycystic ovary syndrome: the management of infertility." Human Fertility, 12(4), 209-218.
16. Ehrmann, D. A. (2005). "Polycystic ovary syndrome." New England Journal of Medicine, 352(12), 1223-1236.
17. Wild, R. A., et al. (2010). "Long-term health consequences of PCOS." Human Reproduction Update, 16(3), 231-241.
18. Barry, J. A., et al. (2014). "Risks and benefits of hormone replacement therapy for women with polycystic ovary syndrome." The Journal of Clinical Endocrinology & Metabolism, 99(9), 1-9.
19. Moran, L., et al. (2009). "Dietary composition in the treatment of polycystic ovary syndrome: A systematic review to inform evidence-based guidelines." Journal of the Academy of Nutrition and Dietetics, 109(4), 575-584.
20. Hutchison, S. K., et al. (2011). "Exercise Improves Insulin Resistance and Body Composition in Overweight and Obese Women with Polycystic Ovary Syndrome." The Journal of Clinical Endocrinology & Metabolism, 96(1), E107-E114.
21. Legro, R. S., et al. (2007). "Insulin resistance in the polycystic ovary syndrome: Mechanism and implications for pathogenesis." Endocrine Reviews, 28(6), 785-800.
22. Palomba, S., et al. (2009). "Ovulation induction in women with polycystic ovary syndrome: treatment options." Best Practice & Research Clinical Obstetrics & Gynaecology, 23(5), 621-631.
Author: Mr Osama Naji
Mr Naji offers a “one-stop” gynaecology clinic for instant detection of various gynaecological cancers as well as providing all the diagnostic and treatment services needed under one roof.
Mr Naji provides advanced gynaecology scanning which is essential when conducting any gynaecology consultation, he is bilingual in English and Arabic and has an NHS base at the highly reputable Guy's and St Thomas' Hospital in London.
He is passionate about raising awareness of various subtle signs and symptoms of gynaecological conditions that are often overlooked by patients.
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