Can you have polycystic ovaries without having PCOS? Let’s talk about Polycystic ovaries & whether it is possible to have them, without having PCOS (Polycystic Ovarian Syndrome).

You’ve been diagnosed with polycystic ovaries, but what does that mean? Does it mean that you have PCOS? Or perhaps the diagnosis for PCOS is inconclusive at this stage & your GP or Gynaecologist hasn’t confirmed the diagnosis.

Hello, I am so thrilled to be here.

For those of you that don’t know me, my name is Michelle Cooke, Period & Hormone Naturopath, Natural Fertility Educator & Naturopathic Emotional Release (NER) Practitioner. I help women struggling with their menstrual cycles, have easy, pain-free periods, balanced hormones & emotional wellbeing. I’m the Founder and Director of Reproductive Wellness, a clinic located in Melbourne. I see patients online and face-to-face.

What are Polycystic ovaries?


Before we talk about that, our ovaries normally contain follicles which is a small sac of fluid which contains one immature developing egg (oocyte) per follicle. At various stages of our cycle under the influence of our hormones the follicle will develop from the primordial follicle > primary follicle > secondary follicle > Graafian follicle / mature follicle. One of those ovarian follicles are chosen which results in ovulation. Then the sac left over after ovulation is known as the corpus luteum (yellow body) which secretes progesterone in the luteal phase of the cycle & if fertilisation doesn’t take place from the sperm it then turns into the corpus albicans (white body).


PCO or Polycystic ovaries affect about 1 in 4 women. There is normally a large amount of premature follicles, so they are only partially developed in your ovaries. The word ‘polycystic’ translates to many cysts. Because there are several follicles, this will cause the ovaries to enlarge.

Hormone wise, the research indicates that women that do have PCO don’t quite have PCOS, however there can be an imbalance of girly hormones just perhaps not to the extent of PCOS.

Genetically, there can be issues with glucose intolerance, insulin resistance or high blood sugar issues.


How is it diagnosed?


Ultrasound of the ovaries that will show multiple immature follicles. The diagnostic criteria of PCO: based on the Rotterdam Criteria of 12 or more cysts of 2-9mm.


Symptoms of Polycystic ovaries


  • Asymptomatic (no symptoms) for some women

  • Irregular periods

  • Anovulatory cycles (ovulation didn’t take place)

  • Mild pelvic pain


How does it happen?


It is thought that PCO may develop due to:

  • High oestrogen

  • High androgens (male hormones) especially testosterone due to high LH (luteinising hormone)

  • High androgens due to high levels of insulin (the high insulin will lead to lack of ovulation & cysts are formed)



What are the risks?


  • Type 2 diabetes (if glucose & insulin are not managed through diet & lifestyle)


What is PCOS?

PCOS or Polycystic Ovarian Syndrome is a condition or “syndrome” which is a collective of symptoms. It’s diagnosed in 1 in 10 women. It’s known as a metabolic condition where there are commonly hormone imbalances whether it be insulin, glucose, testosterone or oestrogen.

It is a multiglandular condition, more than one hormone producing gland is involved. If you imagine a 5 legged stool it involves the pancreas, adrenals, thyroid, pituitary and ovaries.

What are the symptoms of PCOS?

  • Acne

  • Oily skin

  • Male pattern baldness or hair thinning

  • Hirsutism (unwanted hair growth on various locations of the body – chest, back, stomach, chin, upper lip, nipples, boobs etc.)

  • Weight gain around the middle

  • Acanthosis nigricans (darkening of the skin)

  • Skin tags

  • Pelvic pain

  • PMS like symptoms

  • Anovulatory cycles

  • Irregular menstrual cycles: oligomenorrhoea (irregular or inconsistent periods) or amenorrhoea (absence of a period)

  • Mood swings: depression

How does it happen?

  • High oestrogen

  • High androgens (male hormones) especially testosterone due to high LH (luteinising hormone)

  • High androgens due to high levels of insulin (the high insulin will lead to lack of ovulation & cysts are formed


What are the risks of PCOS?

  • Diabetes

  • Cardiovascular Disease

  • Obesity

How is PCOS diagnosed?


In order to have PCOS it is generally diagnosed using the Rotterdam Criteria. You need to have 2 out of 3 of the following:

  1. Polycystic ovaries discovered on ultrasound

  2. Symptoms and signs or blood test evidence of too many androgens or hyperandrogenism (high levels of male hormones) like testosterone: hair loss on head, hirsutism, acne etc.

  3. Oligo-anovulation (irregular ovulation, ovulation not taking place or menstrual cycles longer than 35 days).

If you ONLY have polycystic ovaries, this does not mean you have PCOS. So if you have been diagnosed only based on this with the syndrome, you need to get a second opinion.

Can you have PCO without having Polycystic ovarian Syndrome (PCOS)?

The answer is yes, absolutely. You can have polycystic ovaries and not have PCOS. This is totally possible. Remember to have PCOS you need to tick 2 out of the 3 boxes for confirmation of the diagnosis.


What should I do if I have PCO or PCOS?

It is important to get diagnosed by a doctor or preferably a gynaecologist because they specialise in girly hormones and specialise specfically in that field. Unfortunately, I hear of some doctor’s just diagnosing PCOS based on confirmation of polycystic ovaries alone, this is not enough to warrant diagnosis of PCOS.

Also, I hear of patients where they have polycystic ovaries were present but the diagnosis of PCOS is inconclusive. This is when I seek another medical professionals opinion. Because anyone familiar with the Rotterdam Criteria would be familiar with what needs to be there in order to have PCOS.

Medical approach is commonly oral contraceptive pill or metformin to manage blood sugar levels & insulin.

My other additional suggestion is to see a Naturopath. Have a Naturopath on your health care team that specialises in Periods & Hormones like myself; to help support you in a wholistic way both for the treatment of all the contributing factors to you have PCO or PCOS

– Natural medicine: including herbal medicine & nutritional medicine, diet & lifestyle to address the root causes of PCO or PCOS


  • Assessing hormone imbalance (pathology testing): a Naturopath reads pathology testing very differently to a GP. We look to see if your results are optimal (which is a a smaller range within the massive pathology range). We will address things before things massively fall of the wagon & become an even bigger issue. 

  • Assessing gut health (microbiome testing): PCOS & PCO are known to disrupt the microbiome or the family of microorganisms living in your gut. Largely due to high glucose levels which bad bacteria love & inflammation to the lining of the gut which arises in an imbalance of good & bad bacteria there. I would generally look at getting a microbiome test done to assess large bowel & potentially a SIBO test (if appropriate based on symptoms) to assess the small intestine. 

  • Assessing vaginal microbiome (microorganisms that live there – bacteria, fungi etc.) – again if appropriate, this is a vaginal swab. 

This is very thorough & it looks at: all different species of bad bacteria, STDs, fungi, beneficial bacteria.

 I also recommend seeing a Naturopath because the best way moving forward isn’t just to simply to stop you from ovulating & shut off hormone production (which is what the pill does). You need to address the reasons why it is happening in the first place, because once you come off the pill, all your symptoms will come back with avengence when your period returns.

I use a combination of herbal medicine, nutritional medicine, NER (Naturopathic Emotional Release) to look at underlying emotional contributors, diet & lifestyle advice to treat each individual based on the clues gained from the pathology testing.

If you are experiencing PCO, PCOS (or perhaps both of them) or your suspect maybe you may have one or both of these, I would love to help you, go ahead and book a FREE 15 min discovery call to find out more about how we would work together and if we are a good fit. 


 You’ll love these blogs 

‘Is Inflammation the bad guy in PCOS’

‘PCOS more than just the ovaries’

Check out my interview with Tsuno about PCO vs PCOS

‘A PCOS Q & A with Michelle Cooke’

If you have any questions or comments please pop them in the comments box below 🙂