Ovarian cyst vs PCOS: The differences

Do you know that ovarian cysts and polycystic ovarian syndrome (PCOS) are not the same? Let's explore their differences in this article.

A black doctor and a black nurse in a surgery room operating on a patient

Key takeaways:

  • An ovarian cyst is a fluid-filled sac that forms within or on the surface of one or both ovaries.
  • PCOS is a hormonal disorder that affects the ovaries of women in their reproductive years.
  • Ovarian cysts and PCOS both may affect the ovaries, but they are not the same.

People often confuse ovarian cysts with PCOS. Both conditions affect the ovaries but have different causes, symptoms, and treatments. 

This article will discuss the differences between ovarian cysts and polycystic ovary syndrome (PCOS), explaining their causes, symptoms, diagnostic methods, and treatment options.

What is an ovarian cyst?

An ovarian cyst is a sac filled with fluid that develops either within the ovaries or on their surface. Most women may have ovarian cysts without experiencing any symptoms.

Ovarian cysts appear in different sizes, ranging from small, usually harmless cysts to larger ones that may cause discomfort or health complications.

What is polycystic ovarian syndrome (PCOS)?

Polycystic ovarian syndrome is a hormonal disorder that affects the ovaries and can have health implications for women during their reproductive years.

According to the WHO, PCOS affects 8–13% of women in their reproductive years, and 70% of the people affected worldwide are undiagnosed.

Multiple cysts on the ovaries, irregular menstrual cycles, hormonal imbalances, and excessive production of male hormones are major symptoms of PCOS.

The difference between ovarian cysts and PCOS

Ovarian cysts are fluid-filled sacs that develop within or on the surface of the ovaries (glands that produces and stores the female eggs).

Most ovarian cysts are harmless and resolve on their own without causing noticeable symptoms. However, larger cysts or those that cause complications can lead to pain around the waist, bloating, pressure, and discomfort. 

In rare cases, ovarian cysts may cause cancer, requiring medical intervention.

On the other hand, PCOS is a medical condition seen in women of reproductive age. Common symptoms include multiple cysts on the ovaries, irregular or absent periods, acne, excessive hair growth, and increased production of male hormones. 

Research shows that people with PCOS are at a higher risk of developing insulin resistance, which can lead to type 2 diabetes, obesity, and heart problems.

While ovarian cysts can occur at any age, PCOS is seen in women of reproductive age. 

A table showing the differences between ovarian cysts and PCOS

Ovarian cyst vs PCOS



Ovarian cyst

Polycystic Ovarian Syndrome (PCOS)


Time of occurrence

Occurs at any age

Occurs during a woman's reproductive age



It is a fluid-filled sac that develops within or on the surface of an ovary.

It is a hormonal disorder that affects the ovaries and other body systems. 



Hormonal problems, endometriosis, and severe pelvic infection

Causes are unknown



Pelvic pain, bloating, pressure, and discomfort

Multiple cysts on the ovaries, irregular or absent periods, acne, and excessive hair growth



Typically diagnosed through ultrasound imaging

Diagnosed based on symptoms, hormonal levels (elevated androgens), and ultrasound is used to demonstrate polycystic ovaries



Is often managed or may require surgical removal if it is large or causing severe symptoms

Lifestyle changes (weight management and exercise), hormonal birth control, and fertility treatments to regulate periods and improve fertility


Health implication

Low risk of developing cancer

Associated with long-term risks, including type 2 diabetes, heart disease, and endometrial cancer if not managed

Can you have PCOS without cysts on the ovaries?

Yes, it is possible to have PCOS without having cysts on your ovaries. 

The name "polycystic ovarian syndrome" can sometimes be misleading because not all individuals with PCOS will have visible cysts on their ovaries.

The presence of ovarian cysts is just one way to diagnose PCOS, and many women with PCOS do not have this feature.

Does ovarian cysts in people with PCOS cause pain?

Ovarian cyst itself does not cause pain in people with PCOS; it is typically painless and does not cause discomfort.

However, PCOS itself can cause various symptoms, and some individuals with PCOS may experience pain around their waist or discomfort for reasons unrelated to ovarian cysts.

Pain associated with PCOS is often due to other factors, such as:

  • Bleeding
  • Ovulation pain
  • Ruptured ovary
  • Twisting of the ovary
  • Irregular menstruation

If you have PCOS and are experiencing pelvic pain, it's essential to consult with a healthcare professional.

PCOS diagnosis vs. ovarian cyst diagnosis

Let's look at how healthcare professionals diagnose each condition.

Diagnosing Polycystic Ovarian Syndrome (PCOS)

In diagnosing PCOS, healthcare professionals look out for three features known as the Rotterdam Criteria. This is a widely accepted method; having any two may show that you have PCOS.

  • Irregular or absent menstruation.
  • High androgen level (such as excessive hair growth or acne).
  • Multiple small cysts on the ovaries

The following examinations will also be carried out by a doctor before concluding your diagnosis.

Medical history and symptoms assessment: This involves taking a detailed medical history and discussing the patient's symptoms. Common symptoms include irregular menstrual cycles, excess hair growth, and acne.

Pelvic ultrasound: In PCOS, the ovaries may appear enlarged and contain multiple small follicles, giving them a "polycystic" appearance. The presence of polycystic ovaries alone is not enough for a PCOS diagnosis.

Blood tests: They are important for assessing hormonal imbalances associated with PCOS. It involves measuring levels of hormones like testosterone, androgen, and insulin. Elevated levels of these hormones and insulin resistance are common in women with PCOS.

Diagnosing Ovarian Cysts

The diagnosis of ovarian cysts involves a different set of methods, including

Questions about symptoms and medical history: Healthcare professionals begin by taking a medical history and asking about symptoms. 

Pelvic ultrasound: Transvaginal or abdominal ultrasound is the primary method to diagnose ovarian cysts. It allows healthcare professionals to view the cyst's size, location, and characteristics.

CT or MRI scans: Mostly done if the cyst is complex or there is suspicion of cancer, a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be recommended for a more detailed view.

Treatment for PCOS vs. treatment for ovarian cyst

PCOS and ovarian cysts affect the ovary, and their treatment approaches differ. Let's look at each treatment option separately:

Treatment for PCOS

Lifestyle changes: Lifestyle modifications, such as eating balanced meals and exercising regularly, may be recommended. Weight management can help improve hormonal imbalances.

Oral contraceptives: Birth control pills can regulate menstrual cycles and reduce androgen levels, which can help manage symptoms like acne and excess hair growth.

Anti-androgen medications: Doctors sometimes prescribe medications like spironolactone for people with PCOS to reduce the effects of androgens (male hormones) in the body, improving symptoms like excess hair growth and acne.

Metformin: This medication is often used to improve insulin sensitivity, which can help with weight management and regulate menstrual cycles.

Fertility Medications: For individuals who want to get pregnant, their doctor may prescribe fertility drugs like clomiphene or letrozole to induce ovulation.

Laparoscopic ovarian drilling: In cases where other treatments have failed, a doctor may carry out this surgical procedure, usually with a small cut below the belly button. This procedure helps improve the way the ovaries produce and respond to hormones, increasing the chance of ovulation.

However, risks associated with this procedure include infection and adhesions.

Treatment for ovarian cysts

An ovarian cyst can occur and resolve on its own without treatment. But if it causes symptoms or complications, treatment may be necessary.

Watchful Waiting: If the cyst is small and not causing symptoms, a doctor will recommend monitoring it over time to see if it resolves.

Medications: Healthcare professionals may recommend hormonal contraceptives (birth control pills) to regulate the menstrual cycle and prevent new cysts from forming.

Surgery: If a cyst is large, causing severe pain, or appears suspicious, surgical removal (cystectomy) may be necessary. In other cases, the whole ovary may need to be removed (oophorectomy).

Pain management: Over-the-counter pain medication such as ibuprofen may be prescribed by a doctor to help manage pain associated with ovarian cysts.

Final thoughts

While both PCOS and ovarian cysts involve the ovaries and can cause similar symptoms, they are distinct conditions with different underlying causes and treatment approaches. 

PCOS is primarily a hormonal disorder with associated cysts, whereas ovarian cysts can develop for various reasons not related to hormonal imbalances. Proper diagnosis and treatment depend on distinguishing between these conditions.

It's essential to consult with a doctor for proper evaluation and guidance on the most appropriate treatment.


  1. InformedHealth.org (2019). Ovarian cysts
  2. World Health Organization (2023). polycystic ovary syndrome
  3. Christ JP, Cedars MI. (2023). Current Guidelines for Diagnosing PCOS
  4. Eunice KS,(2022) How do health care providers diagnose PCOS?
  5. Mobeen S, Apostol R. (2023). Ovarian Cyst
  6. Akre S, et al. (2022). Recent Advances in the Management of Polycystic Ovary Syndrome
  7. Bordewijk EM, et al. (2020). Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome
  8. American College of Obstetricians and Gynecologists (2023). Ovarian cysts