Bilateral PCOS – Symptoms, Causes, Complications & Treatment

PCOS, also known as polycystic ovary syndrome, is a common hormonal disorder affecting women of reproductive age. One finding that is often linked with PCOS is bilateral polycystic ovaries. But what does it actually mean?

Well, it simply means that both ovaries have multiple small follicles visible on an ultrasound. If you’ve recently been told you have bilateral polycystic ovaries, it’s completely natural to feel confused or concerned, especially about what this means for your health and fertility. The good news is that this condition is manageable, and with the right guidance, many women go on to lead healthy lives and conceive successfully.

In this blog, we’ll explain what bilateral polycystic ovaries mean, why they happen, and the symptoms you might notice.

What are Bilateral Polycystic Ovaries?

Bilateral polycystic ovaries refer to the presence of multiple small cysts in both ovaries. This condition is a hallmark of PCOS, which is characterised by hormonal imbalances that can lead to ovulation disorders and various other symptoms. These hormonal changes can interfere with ovulation, which may lead to symptoms such as irregular periods, acne, or more. If you are wondering then if these cysts are harmful then the simple answer is no. They are more like immature eggs that were not developed or were releases before. 

However, not all women with polycystic ovaries have PCOS. The presence of polycystic ovaries alone does not necessarily indicate PCOS, as other diagnostic criteria must also be met.

To diagnose PCOS, doctors consider a combination of factors, not just ultrasound results. These include menstrual irregularities, signs of excess androgens (male hormones), and hormonal blood tests. This is why a thorough evaluation by a specialist is essential before arriving at a diagnosis or treatment plan.

Difference Between PCOS & Bilateral PCOS

Although both PCOS and bilateral PCOS are hormonal conditions that impact women, they have minor differences:

Factors	PCOS	Bilateral PCOS
Meaning	A condition characterized by multiple small cysts on one or both ovaries, along with hormonal imbalances and other symptoms.	A subtype of PCOS where cysts are present on both ovaries.
Nature	A medical condition/syndrome	A structural or imaging finding
Hormonal Imbalance	Present in this condition	May or may not be present in this finding
Menstrual Cycle	Women face delayed, irregular, and even missed periods at times	Women might face irregular periods
Ovulation	Often regular or absent	Maybe normal in many women
Symptoms	Acne, excess facial/body hair, weight gain, hair thinning, infertility	Often asymptomatic
Fertility Impact	It can affect fertility due to ovulation issues	Fertility will be normal if PCOS is not present
Long Term Risks	Higher risk of diabetes, metabolic syndrome, and endometrial issues	No added long-term risk by itself

How to Identify Bilateral PCOS?

Bilateral PCOS is usually identified through a combination of symptoms, medical history, blood tests, and imaging studies. Since PCOS is a hormonal condition, doctors don’t rely on just one test. Instead, they examine a pattern of signs indicating hormonal imbalance and irregular ovulation, along with changes observed in both ovaries on ultrasound. We will discuss it broadly below. 

What Causes Bilateral Polycystic Ovaries?

While the exact cause of bilateral polycystic ovaries is not fully understood, several factors are believed to contribute to its development. Some of them include:

• Insulin Resistance: High insulin levels promote excessive androgen production, which disrupts ovulation and results in ovarian cysts.
• Chronic Low-Grade Inflammation: It can cause the ovaries to produce more androgens, leading to the formation of cysts.
• Genetic Predisposition: A family history of PCOS increases the risk due to genetic factors.
• Hormonal imbalances: Excess androgens and abnormal LH/FSH levels impede ovulation, which is the cause of cysts.
• Lifestyle Factors: Obesity is one of the lifestyle factors that might exacerbate symptoms.

Risk Factors for Developing Bilateral Polycystic Ovaries

Certain factors can increase a woman’s likelihood of developing bilateral polycystic ovaries, including:

• Family history: Women with a family history of PCOS are more likely to have the condition.
• Obesity: Being overweight or obese is a significant risk factor for bilateral polycystic ovaries since it can exacerbate insulin resistance and hormonal abnormalities.
• Ethnicity: While not exclusive, bilateral polycystic ovaries are more prevalent in particular ethnic groups.
• Other medical conditions: Women with type 2 diabetes, high blood pressure, or high cholesterol are more likely to have bilateral polycystic ovaries.

What are the Symptoms of Bilateral Polycystic Ovaries?

There are some common symptoms of bilateral polycystic ovaries, but they can vary from woman to woman.  Let’s check them out:

• Irregular Periods: PCOS is frequently indicated by irregular or infrequent menstrual cycles. This also applies to having periods that are longer than usual or persist for several days. For instance, you may experience fewer than nine menstrual cycles annually. Additionally, those intervals might exceed 35 days. It can be difficult for you to conceive.
• Excess Androgen: Excessive body and facial hair can be caused by elevated androgen levels. We refer to this as hirsutism. Male-pattern baldness and severe acne can also occur occasionally.

• Acne and Oily Skin: Increased sebum production can lead to acne and oily skin in women. 

• Insulin Resistance: Weight control can be challenging due to insulin resistance, which is often associated with weight gain or difficulty losing weight.
• Thinning Hair on the Scalp: Reduced density caused by hormonal changes or hair loss resembling male-pattern baldness.

Complications Associated With Bilateral Polycystic Ovaries

If left untreated, bilateral polycystic ovaries can lead to several health complications:

• Infertility: One of the major complications associated with bilateral PCOS is ovulation problems that make conceiving difficult in women. 

• Insulin resistance and type 2 diabetes: Insulin resistance is a key factor in PCOS, increasing the risk of developing type 2 diabetes.

• Heart disease: High blood pressure, high cholesterol, and obesity associated with PCOS increase the risk of heart disease.

• Sleep apnea: Obesity and insulin resistance in PCOS can increase the likelihood of sleep apnea. 

• Endometrial cancer: Irregular menstrual cycles can lead to thickening of the uterine lining, increasing the risk of endometrial cancer.

Diagnosing Bilateral Polycystic Ovaries

A multifaceted strategy that considers your symptoms, physical examination results, and diagnostic test results is usually used to diagnose bilateral polycystic ovarian morphology. The following could be suggested by your physician:

• Physical examination- The first step of diagnosis is to look for physical indications such as acne or excessive hair growth. 
• Medical history- After the physical symptoms are checked for, the menstrual cycle pattern and other health conditions are reviewed. 
• Pelvic exam- A comprehensive assessment to find any anomalies in your reproductive organs.
• Hormone tests- Insulin and androgen levels are measured. 
• Ultrasound- Confirming the presence of several ovarian cysts. Having 12 or more follicles with a diameter of 2–9 mm or an ovarian volume greater than 10 mL in one or both ovaries is known as polycystic ovarian morphology.

Treatment Options for Bilateral Polycystic Ovaries

Controlling symptoms and preventing consequences are the main objectives of treatment for bilateral polycystic ovaries. The plan may include both non-surgical and surgical options:

Non-surgical Treatments

Medications:

• Hormonal birth control pills, also known as oral contraceptives, can help reduce androgen levels. Patches or Intrauterine Systems (IUSs) are used to regulate menstrual cycles. 
• Medications like clomiphene and gonadotropins help induce ovulation in women who are trying to conceive. 
• Metformin improves insulin sensitivity and reduces the risk of diabetes.
• There are anti-androgen medications that are recommended by the specialists. These include spironolactone, finasteride, and cyproterone acetate, which help manage hirsutism and acne. 

Dietary supplements:

• Some supplements, such as inositol, may help improve insulin sensitivity and reduce androgens.

Surgical Treatments

1. Ovarian drilling: A minimally invasive procedure that involves making small holes in the ovaries to restore ovulation.
2. Laparoscopic ovarian diathermy: A surgical procedure that uses heat to destroy the androgen-producing tissue in the ovaries.

Lifestyle Changes for Managing Bilateral Polycystic Ovaries

Making sustainable lifestyle changes is a crucial component of managing PCOS and promoting overall health. Some key areas to focus on include:

• Diet: Diet is an important part of lifestyle changes that help manage bilateral polycystic ovaries. One should add fruits, vegetables, whole grains, lean protein, and healthy fats to their diet. These diets help regulate blood sugar and insulin levels. 

• Exercise: Regular exercise or toga for 15-20 minutes can significantly improve insulin sensitivity, regulate menstrual cycles, and reduce weight gain associated with bilateral PCOS. 

• Stress Management: Stress reduction techniques such as yoga, meditation, and even counselling can help manage the psychological and emotional aspects of bilateral PCOS.

These are the small changes that can help manage this condition. 

Bilateral PCOS and Impact on Fertility

If you’re wondering how bilateral polycystic ovaries can impact fertility, then the simple answer is by disrupting regular ovulation. When both ovaries have polycystic changes, hormonal imbalances, especially elevated androgens and insulin resistance, can interfere with the normal development and release of eggs. This can result in irregular or ceased ovulation, which makes it more challenging to predict fertile days and conceive naturally. 

Apart from these issues, bilateral PCOS can impact egg quality and the uterine environment. This further reduces the chances of pregnancy. There are many women who experience irregular periods, which can delay diagnosis and treatment. The good news is that most women with bilateral PCOS can successfully conceive and have healthy children with prompt medical care, including lifestyle modifications, ovulation-induction drugs, and assisted reproductive methods like IUI or IVF.

Getting Pregnant With Bilateral Polycystic Ovaries

It is true that bilateral polycystic ovaries can make conceiving naturally challenging. But that doesn’t mean pregnancy is not possible at all. There are many cases in which women with PCOS, including those who have bilateral polycystic ovaries, have successfully achieved healthy pregnancies. In cases where a natural pregnancy is not happening, there are multiple fertility treatments that can help with the same. 

Here, we have mentioned the most common fertility treatment options:  

Fertility Treatment	Description	Success Rate
Ovulation induction	Medications like clomiphene citrate or letrozole helps to stimulate ovulation	40%-50%
IUI ( Intrauterine Insemination)	In this the sperm is directly placed inside the uterus	10%-20% per cycle
IVF ( In Vitro Fertilisation)	In this the fertilisation of eggs happens outside the body and then the embryo is placed inside the uterus after fertilisation	40%-50% per cycle

Myths and Facts About Bilateral PCOS

There are a lot of myths about bilateral PCOS that make women set their treatment in the wrong direction. Sometimes they do not even take it seriously because of the myths mentioned below. Let’s bust these myths today with actual facts:

Myth 1: Women suffering from bilateral PCOS can never get pregnant.

Fact: This is completely untrue. Many women with bilateral PCOS conceive naturally or with the help of medical support. With the right treatment plan, pregnancy is possible. 

 

Myth 2: Bilateral PCOS and PCOS are completely different. 

Fact: Bilateral polycystic ovaries are a common feature of PCOS, but having cysts alone does not confirm PCOS. Diagnosis depends on multiple factors, not just ultrasound findings.

 

Myth 3: It is a severe condition, especially when both ovaries are affected. 

Fact: The number of cysts in the ovaries does not reflect the severity of this condition. The symptoms and hormone levels matter more than the ultrasound appearance. 

 

Myth 4: Surgery is the only solution for bilateral PCOS.

Fact: No, many cases can be managed with simple lifestyle changes. Other generally involves medication and fertility treatments. Surgery is rarely the first option. 

 

Myth 5: Irregular periods are the only symptom of bilateral PCOS.
Fact: PCOS can also cause acne, weight gain, excess hair growth, ovulation issues, and insulin resistance.

 

Myth 6: IVF is the only way to conceive with bilateral PCOS.
Fact: Many women conceive with ovulation-inducing medicines or simpler fertility treatments. IVF is recommended only when needed.

 

Myth 7: Bilateral PCOS goes away on its own.
Fact: PCOS is a long-term condition, but symptoms can be effectively managed with the right medical guidance and lifestyle support.

FAQs

Can bilateral PCOS be cure by exercise?

No, exercise cannot cure bilateral PCOS. However, it can significantly help manage symptoms by correcting hormonal imbalances. 

 

How does bilateral PCOS impact fertility?

Bilateral PCOS impacts fertility by disrupting regular ovulation.

 

Is bilateral PCOS reversible?

Bilateral PCOS is not completely reversible, but its symptoms can be effectively managed with the right lifestyle changes and medical treatment.

 

Can women gain weight because of bilateral PCOS?

Yes, women can gain weight because of bilateral PCOS since it imbalances the hormones in the body. Insulin resistance also occurs in women with this condition, but regular monitoring and lifestyle changes can help with weight. 

 

Does bilateral PCOS cause early menopause?

No, bilateral PCOS does not cause early menopause. In fact, many women with PCOS tend to reach menopause later due to a higher number of ovarian follicles.

 

Which diet helps in overcoming bilateral PCOS?

By increasing insulin sensitivity, a low-glycaemic, high-fiber diet aids in the management of bilateral PCOS. Limit sugar and refined carbohydrates and emphasise whole grains, lean protein, healthy fats, and veggies.

 

Can diet make a difference?

Yes, having a balanced diet can make a difference when it comes it bilateral PCOS.