Is a Routine Ultrasound Scan Necessary for the Diagnosis of Polycystic Ovarian Syndrome?

Polycystic ovarian syndrome (PCOS) is common among women of reproductive years and patients with this condition may be referred to an endocrinologist, a gynaecologist or a dermatologist, depending on their main presenting complaint. A recently mailed questionnaire to endocrinologists and gynaecologists showed a lack of consensus between the two specialties in the definition, diagnosis and treatment of PCOS. Can routine ultrasound for the imaging of polycystic ovaries be dispensed with? In large measure, the answer is 'yes'. First, polycystic ovaries are common in women without PCOS and not all women with PCOS have polycystic ovaries. Secondly, if the patient has irregular periods and biochemical hyperandrogenism, why scan? Thirdly, the operator dependence of the technique may give false positive and negative scan results. Economically and practically, ultrasound scanning in PCOS should be limited to cases of diagnostic uncertainty performed by a recognized expert in pelvic ultrasonography.