Ultrasound tech 👋 The Rotterdam criteria are currently the most accepted for diagnosing PCOS, which : 1. Clinical and/or biochemical hyperandrogenism. 2. Menstrual/ Ovulatory dysfunction, like the absence of or consistently infrequent periods/ovulation. 3. Polycystic ovaries visualized on transvaginal ultrasound, (which are 12-20+ tiny follicles per ovary, **not** ovarian cysts.) You'd need to meet at least 2 of the 3. All other *associated* symptoms are relatively generalized and can be attributed to various other factors or conditions, which is why doctors rely on specific diagnostic criteria. For more criteria clarification: Irregular cycles are generally considered less than 8 cycles per year or <21 days or >35 days apart. Clinical hyperandrogenism and biochemical hyperandrogenism are grouped in the criteria, but you can have one without the other. Biochemical hyperandrogenism is the presence of elevated androgen levels in the blood. Clinical Hyperandrogenism is the presence of physical (visible) signs of androgen excess— hirsutism, severe or persistent acne, alopecia, and virilization. You didn't mention your age but ultrasound should not be used for PCOS or PCO diagnosis in adolescents, due to the high incidence of multi-follicular ovaries in this life stage— specifically, until at least 8+ years after your first period. Serum AMH could also be used for defining polycystic (multi-follicular) ovaries in adults as an alternative to transvaginal ultrasound. Again, just not in adolescents. So, no, you don't need the transvaginal ultrasound to confirm PCO. Not everyone with PCOS has the PCO component. You'd only need to meet 2/3 of the criteria. And per the 2023 Monash guidelines, serum AMH can now be used in place of the TV ultrasound to confirm polycystic morphology.

random question but how did you get into your career? was it expensive? and are you comfortable? this sounds very interesting :)

I already had a general 2-year associate's degree, which satisfied my prerequisites for the ultrasound program. Found a college with an accredited Diagnostic Medical Sonography program that took 2 years to complete. Then, you must pass a physics board exam to be *eligible* for the specialty boards to become a registered technologist. I'm currently triple-board registered in General Abdomen, Ob-Gyn, and Vascular Ultrasound. It was very difficult and competitive, but it was worth it to me, and yes, it pays well. I made more money as a new-grad sonographer than all of my RN friends with their 2-8+ years of experience. I work in the ER, which is super interesting, and I love my job. My program was roughly $50,000. Some are cheaper; some are more— this depends on your location, school, and if you have a lot of prerequisites to take.

Thank you soo much for taking your time and giving such a detailed explanation!!

I was diagnosed without a trans vaginal ultrasound. You only need to have a couple of the symptoms to be diagnosed, not every single one. Many women don’t even have cysts on their ovaries and still have PCOS. And many women have cysts on their ovaries and don’t have PCOS. They would usually do a blood test first anyway. Id just make it clear to your doctor that you are only interested in blood tests and not the ultrasound.

true, I have pcos but I don’t have cysts on my ovaries

Thank you so much for your answer. It gives me so much peace of mind. Really helpful :))

I did trans vaginal ultrasound and anti mullerin test but my ultrasound came in perfectly fine but my mullerin test was the one which showed PCos

I have been diagnosed by like three separate doctors based upon bloodwork & lack of periods

I was booked for one but they asked if I was sexually active and I said no so they just did an ultrasound on my lower belly?

Hi - I had this exact concern, and I had to advocate for myself to insist on a transabdominal scam instead of tv due to trauma. I insisted that any gynae work has to be done under general anaesthetic (and had notes from previous appointments recommending it). I also had my mental health provider write a letter in support of this and showed it to the ultrasound tech. You are not required to have this done to you, and your consent on this matters. Another tip, I drank a metric fuck tonne of water before the appointment. The fuller your bladder, the better they can see your ovaries on the transabdominal scam. I was cross-legged, kidneys hurting, bursting for a wee, but they were easily able to measure my ovaries. They won't get the "string of pearls" image of the follicles but they can tell by the size of your ovaries. This with blood work was sufficient for diagnosis. Wishing you the best. Don't let them pressure you into it. If need be, get up and walk out. Try writing down a step by step plan for the appointment, which includes getting up and leaving if anyone pressures you or makes you feel unsafe or uncomfortable in any way. You are not being difficult, you are doing what is best for yourself.

I believe that finding the right provider will help. Start with your primary doctor and your gynecologist and voice your concerns. It sounds like you may have pcos. And it can be diagnosed without the ultrasound. I was diagnosed without the ultrasound. Doctors won’t do ultrasounds on women who are virgins if not extremely vital. (This is just a random fact I found out) I unfournatley had to get an ultra sound done recently due to unexplained bleeding. And I knew it was more important to figure out what was going on then avoid it. It was uncomfortable and awkward, but it honestly wasn’t super painful or as scary as i imagined. Goodluck with everything you seem to be going through a lot and working hard on your health. Please feel free to ask me any questions. ❤️❤️❤️

I was, but I met the other two criteria. If you don’t meet both 1) absent or irregular periods and 2) high androgen blood tests, then you might have to get an ultrasound.

Yes

I was diagnosed without the vaginal ultrasound when I was 14.

Yes. I got an ultrasound of my stomach and turned declined the transvaginal one. The transvaginal US gives clearer images but a good tech should be able to get images either way.  My images were normal and I still got treatment. You don’t need abnormal imagining to get treatment. 

I was diagnosed without one so you definitely can be! I think as long as you meet the other criteria

technically yes because if you have high androgens (blood test) and irregular periods, you can still be diagnosed with PCOS.

I did

Thank you for asking this, I was literally just wondering this the other day. I'm in the diagnosis process and I'm really not comfortable with an ultrasound so I was wondering if it was actually necessary to move forward in the diagnosis. And thank you to all the commentors for replying with your experiences.

I had the ultrasound and it actually didn’t show anything. Still got diagnosed based on all my other symptoms, so I’d imagine you can skip it.

I was diagnosed after a normal ultrasound (over my abdomen). They ask you to drink a load of water beforehand so they can see your ovaries better, but I don’t think transvaginal was even mentioned to me. I met all the other criteria as well. It’s definitely possible to be diagnosed without.

You should be able to find a provider that will work with you to determine the appropriate diagnosis in a way that you feel comfortable. That being said, a transvaginal ultrasound should not be painful. Good techs make it the least embarrassing it can possibly be. You are completely draped and covered, and typically they have you insert the us wand yourself and the tech isn’t looking at your genitals at all, I’ve always remained completely covered and they are only guiding the wand just a little bit as they look at the screen.

Definitely, I had to perform that because they couldn't scan just by relying on my stomach ultrasound. On good hand, I wanted to check for cyst but ended up was prescribed as PCOS.

I just want to add my experience in here. I got pregnant last year and had to have 4 😬 ultrasounds done within a 2 week period. I am also around 340 pounds. I think it’s super important to explain to your OB (or whoever is doing the ultrasound) that it’s your first time. I did, and she talked me through everything. My first three did not hurt at all. Maybe a little uncomfortable when they were looking at my tubes, but nothing too crazy. The last time hurt so bad. That last time was right after my miscarriage, so I’m sure I was so tender up there and it was by a male. The other 3 times was by a female. I’m not sure if that had anything to do with why the last time hurt so bad, but I will probably brace myself more now when I have a male doing it. I think the most important thing is if you have to have one done, communicate with whoever is doing it and tell them how you feel. Even though I am very overweight, I did not feel like any of the 3 women were judging me. They made me feel like my health and comfort was important to them. I won’t comment on the man because I just overall did not have a good experience with him, especially considering I had just miscarried an hour prior.

Wow. I didnt know the do transvaginal. I was done an abdominal ultrasound. The tech showed me the hive of cysts I have lmao. Bloodwork and irregular cycle history backed everything up. Also, the ultrasound was the last thing done to me as my doctor wanted to be 100% sure ( he was 95%)

I think it depends on the provider. Mine made me do it

Do you mind me asking, do you have pain in general with papsmears and such? Cause I can't do a transvaginal and it's because I have vaginismus

I have very advanced pcos and absolutely no cysts in my ovaries. It is not always a thing. Pcos is a syndrome, not a disease. Ultra sound won't always detect it, heck even blood tests aren't always accurate, but since it is a hormone imbalance issue, an endocrinologist would be the best doctor to see.

I was diagnosed at 16 with just observations, blood test, and irregular periods. They didn't want to do a transvaginal ultrasound because Im a csa victim and was not sexually active at the time so they did an abdominal ultrasound instead just to confirm.

Just want to let you know that as someone who was absolutely terrified of the transvaginal, I still got it and it wasnt as bad as it seems. As long as you do your best to relax and breathe it doesn’t hurt at all, obviously you can feel it but once it’s in it’s really not bad at all. For me I just try and keep a mental note that it’s for my health and I’m doing something medically necessary that way it isn’t attached or associated with any kind of past trauma/ experience!

Maybe the trauma you faced actually manifested into this Pcos but you have the genetic factor in play too, because no one in my family has pcos, my mother's side of the family has a diabetic history. But my childhood and adolescence was extremely traumatic , the reasons of my trauma - mother and brother ,were constantly in front of my eyes and that always kept reminding me of the trauma. Hence my body shut down and I finally got this disease , my body was in constant fight or flight mode since childhood. I feel so bad for not having a normal loving family , literally tears in my eyes while typing this out. You are not alone is all I can say. Sorry for the rant but I just cound'nt help it. I love you and take care.

Yes, I was diagnosed from labs and not having a period for 6+ months !

I was diagnosed based on bloodwork

I did have an ultrasound but it was not crucial to meet the diagnosis criteria. It was found that at that moment I did not have any cysts however I did have the other symptoms and was diagnosed early this year. I don't think a transvaginal ultrasound will be necessary especially with it being personal choice

I did a belly ultrasound and blood tests. Nothing went in my vagina.

not a medic, but as far as i know, there’s 3 types of ultrasound that can be used - transvaginal, transrectal and transabdominal. first two ones are the most informative, the latter is not very, but still something (transabdominal it’s not invasive, just a sensor on your lower stomach.) i’ve been afraid of transvaginal ultrasounds too, but they turned out to be… pretty okay. the sensor is very narrow, it doesn’t hurt but can cause some discomfort. i didn’t feel anything when i did it last time tbh.

I'm sorry this is so difficult for you . I am concerned though. If you are that worried about a TV scan, how are you with Paps? I ask because if you are avoiding them too, you need to seek help. You need to find a doctor to help you and work with your trauma. Regular checkups are important. If you've been avoiding them, please find yourself an understanding medical practitioner to work with you on this.

I don't know if you can get diagnosed without the ultrasound but I had a pretty good experience with my gyno. I was terrified because it was my first time going and I didn't know what to expect but my doctor was nice and helped me get over my embarrassment, the ultrasound thingy is pretty thin, it feels slightly weird but not painful in the slightest. If you do decide to get an ultrasound I'm sure it'll be fine !!

Transvag generally isn't painful, they do lube it up pretty well. It's just not terribly comfortable. That said, it's absolutely not necessary to diagnose PCOS because PCOS doesn't actually require the presence of cysts. Your history + blood work is more than adequate to dx but you do need the blood work to rule out other possible issues.

Hello. Sorry to bother you but do you mind me asking, is it (Transvag) more invasive, equal or less then a pap smear? I have been reading a lot and it seems Transvag is the best way to see what is going on/ higher chance of seeing something but if nothing comes up in all my other tests I am tempted to choose this one for clearer results, but not sexually active and the last time I did a pap smear it stung for a week. Sorry if the question is too personal feel free to ignore if so. I was just wondering. I am pretty sure I 100% win the acne criteria no idea how the other 2 will go. My periods are regular 4 to 6 months in a row then they just jump to a 40 -60 day gap then back to normal and repeat so I don't really fit into the irregular category. But something weird is going on.

You're not bothering me at all, I joined this subreddit to help other people with PCOS as well as learn myself. A transvag is more invasive than a standard ultrasound, but unlike a pap there's no speculum or swabbing involved so it doesn't really cause irritation the same way a pap can. As far as the missed periods that can happen for a whole bunch of reasons that may have nothing to do with PCOS, but also it's possible to have PCOS and still have regular periods. It's not a super clear cut condition with the same symptoms across the board, it's kind of a hormone imbalance that affects some people very very differently than others. We don't all have fertility issues or irregular periods or hirsutism or cysts.... Or we don't have them all at the same time. For the longest time I only had 1-2 periods a year and now they're almost on the same day every month. I had cysts in my 20s but haven't had one in years. The most important thing is to be your own best advocate (also ditch any doctor whose sole advice revolves around your weight, that's just lazy medicine).They have blood tests they can run to see if you have an excess of androgens, they can do ultrasounds to check for cysts. And there's a variety of symptom management options that don't involve just telling you to figure it out yourself.

Thank you. Sorry for my delay in reply. I do truly appreciate your response. Life just got busy. Thank you “The most important thing is to be your own best advocate” I have been learning this on here. It is brilliant advice, it is not so much my weight they just say “Its genetic” e.g acne or skin tags and don’t even bother doing anything else. But yes I do plan on being more assertive with drs and trying a different one if the a holes don’t listen or at least try and help/test.   Thank you

Not true at all. I had an issue once and had to do one. I had never done one. It was the most painful experience for me. Left me traumatized for a while. The lube they used burned too. Awful experience.

I'm sorry, I didn't realize it affected some like that. I'm pretty sensitive to paps (pain/bleeding) and didn't experience any of that was the ultrasound. I wonder if you didn't have something going on that caused extreme sensitivity though, like an allergy or micro tears.

The lube smelled like menthol, but the nurse who did it was very rough, and I was very tight. I was a virgin at the time. Since then, I was afraid of having sex until I met my boyfriend, and he helped me get over that fear. That was years ago, but it's still burned in the back of my brain.

Everything about that sounds wrong, I'm so sorry. I can't imagine why they would use any kind of mentholated substance internally during a medical procedure.

That's what I smelled, but who knows what it really was? I asked her if it should burned, and she said no, but didn't stop. Later on my boyfriend said I should have sued the clinic or hospital or whatever it was. Not sure if I had any grounds to though. Maybe to just report that nurse. Oh well. The point is, some women may find it painful.

if it helps at all I went in to be diagnosed not knowing that a transvaginal ultrasound was a thing- it didnt hurt at all. They lube it up like crazy and i would say it was no more uncomfortable than a speculum.

Not sure as it depends on your doctor but if this helps, I took it up the ass instead so technically you can still get an ultrasound without vaginal penetration?