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PCOS bilateral polycystic ovarian morphology ultrasound diagnosis 25 year female management
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I now have enough information to give a thorough explanation. Here is a complete breakdown of this ultrasound report:
Ultrasound Report Explained - Ms. D Pranathi Patel, 25F
This is a Ultrasound of the Abdomen and Pelvis, done at Tenet Diagnostics on 23-Jul-2026. Here's what each finding means, in plain language:
NORMAL FINDINGS (Nothing to worry about)
| Organ | Finding | What it means |
|---|---|---|
| Liver | Normal size (12 cm), uniform echotexture, no focal lesion | Completely healthy liver |
| Gall Bladder | Normal shape, clear contents, normal wall, normal CBD | No gallstones, no bile duct problem |
| Pancreas | Head 1.9 cm, Body 1.4 cm - normal | No pancreatitis, no tumour |
| Spleen | Normal size (9.3 cm), normal echopattern | Healthy spleen |
| Urinary Bladder | Normal shape, wall, clear contents, no diverticula | Healthy bladder |
| Uterus | Anteverted (normal position), 7.7 x 4.4 x 2.8 cm - normal size, endometrial thickness 8.2 mm - normal | No fibroids, normal uterus |
FINDINGS THAT NEED ATTENTION (The 4 Key Impressions)
1. Small Non-Obstructive Left Renal Calculus (Kidney Stone)
The report found a 2 mm stone in the mid pole of the left kidney. Key facts:
- "Non-obstructive" means the stone is NOT blocking the urine flow from the kidney itself - it is just sitting there.
- 2 mm is very small (stones under 5 mm usually pass on their own without any procedure).
- What to do: Drink plenty of water (2-3 litres/day). Your doctor may monitor with a repeat ultrasound in a few months. Pain medication (like ibuprofen or diclofenac) is used if you get pain.
2. Left Mild Hydronephrosis - Secondary to ? Mid/Distal Ureteric Calculus
This is the more important kidney finding. The left kidney shows mild swelling (hydronephrosis) because a stone appears to be stuck somewhere in the ureter (the tube that carries urine from kidney to bladder) - either mid-ureter or near the bladder end (distal ureter).
- The radiologist used "?" because the stone in the ureter itself was not clearly visible on ultrasound (ureteric stones are often hard to see directly with ultrasound).
- This is why you may have left-sided flank pain or back pain.
- What to do: This usually needs a CT KUB (CT scan of kidneys, ureters and bladder without contrast) to confirm the location and size of the ureteric stone. Depending on the size, the doctor may prescribe an alpha-blocker (like tamsulosin) to help pass the stone, plus good hydration. Larger stones may need urological intervention (like ureteroscopy).
This finding requires prompt follow-up with a urologist or general physician.
3. Bilateral Polycystic Ovarian Morphology (PCOM)
Both ovaries show multiple small follicles arranged around the periphery with central echogenic (bright) stroma - this is the classic "string of pearls" appearance of polycystic ovarian morphology.
- Right ovary: 2.8 x 2.9 x 1.8 cm, Vol: 8 cc
- Left ovary: 2.9 x 2.9 x 1.6 cm, Vol: 7.3 cc
Important distinction: The radiologist reported "Bilateral Polycystic Ovarian Morphology" - this is a radiological (ultrasound) finding. It does NOT automatically mean you have PCOS (Polycystic Ovary Syndrome).
According to the Rotterdam Criteria (the standard diagnostic criteria), PCOS is diagnosed only when 2 of the following 3 are present:
- Irregular periods (oligomenorrhea or no periods)
- Signs of excess male hormones - clinically (acne, excessive hair growth/hirsutism, scalp hair thinning) OR in blood tests (elevated testosterone, DHEA-S, LH:FSH ratio)
- Polycystic ovarian morphology on ultrasound (which you have ✓)
So you need one more criterion for a formal PCOS diagnosis. - Berek & Novak's Gynecology
Next steps recommended:
- Blood tests: LH, FSH, Testosterone (total and free), DHEA-S, Prolactin, TSH, fasting insulin, fasting glucose, lipid profile
- Review your menstrual cycle history with your gynaecologist
- If PCOS is confirmed:
- Lifestyle changes first: Regular exercise (>30 min/day), balanced diet, weight management
- Combined oral contraceptive pills are first-line to regulate cycles and manage androgens - Harrison's Principles of Internal Medicine
- Metformin if there is insulin resistance or metabolic risk
- Regular screening for blood pressure, blood sugar, cholesterol, and mood disorders
4. Mild Mucosal Wall Thickening of the Sigmoid Colon (4-5 mm)
The sigmoid colon (the lower part of the large bowel) shows mild wall thickening (4-5 mm). The normal colon wall is typically < 3-4 mm.
- Mild thickening like this can be seen with several conditions: irritable bowel syndrome (IBS), minor colitis, constipation, bowel inflammation, or simply a technical finding due to bowel peristalsis at the time of scan.
- In a 25-year-old otherwise healthy woman, the most common causes would be benign (IBS, mild inflammation).
- However, this finding should not be ignored - it needs clinical correlation (any history of loose stools, blood in stools, abdominal pain, change in bowel habits?).
- Your doctor may recommend a colonoscopy to directly look at this area if symptoms suggest it.
Summary Table
| Finding | Urgency | Next Steps |
|---|---|---|
| Left kidney 2mm stone (non-obstructive) | Low - monitor | Hydration, repeat USG in 3-6 months |
| Left hydroureteronephrosis - ? ureteric stone | Moderate - act soon | CT KUB, see urologist, tamsulosin |
| Bilateral polycystic ovarian morphology | Moderate | Blood hormone tests, gynaecologist review |
| Sigmoid colon wall thickening | Low-Moderate | Clinical correlation, consider colonoscopy if symptomatic |
Important Disclaimer
This explanation is for educational purposes only. Please consult your doctor - ideally a general physician, gynaecologist (for the ovarian finding), and urologist (for the kidney/ureter finding) - who can put this report together with your symptoms, examination, and blood tests to give you a proper diagnosis and treatment plan. Do not self-medicate based on this report alone.
Create a symptom tracker checklist for PCOS follow-up (menstrual, metabolic, and mood symptoms)
Asking for Preferences
Here is your monthly PCOS symptom tracker, designed to bring to your gynaecologist each cycle:
🗓️ PCOS Monthly Symptom Tracker
Patient Name: ___________________________
Month / Year: ___________________________
Cycle Number (since diagnosis): ____________
Doctor's Name: __________________________
SECTION 1 — MENSTRUAL SYMPTOMS
Cycle Details
| Details | |
|---|---|
| Did your period come this month? | ☐ Yes ☐ No ☐ Spotting only |
| If yes - Date period started | ___ / ___ / ______ |
| Date period ended | ___ / ___ / ______ |
| Total duration of period | _______ days |
| Days since last period (cycle length) | _______ days |
| Cycle regular compared to last month? | ☐ Yes ☐ No ☐ Not sure |
Flow
| Flow heaviness | ☐ Very light ☐ Light ☐ Moderate ☐ Heavy ☐ Very heavy |
| Clots passed? | ☐ No ☐ Small clots ☐ Large clots |
| Mid-cycle spotting? | ☐ No ☐ Yes |
Menstrual Pain
| Cramps present? | ☐ No ☐ Mild ☐ Moderate ☐ Severe |
| Pain affected daily activities? | ☐ No ☐ Yes |
| Pain medication needed? | ☐ No ☐ Yes - Name: _________________ |
Other Menstrual Notes
- Unusual discharge this month? ☐ No ☐ Yes - Describe: _____________________
- Ovulation pain (mid-cycle)? ☐ No ☐ Yes
SECTION 2 — METABOLIC SYMPTOMS
Weight & Body
| Current weight | _______ kg |
| Change from last month | ☐ Same ☐ Gained ____kg ☐ Lost ____kg |
| Waist measurement (optional) | _______ cm |
| Increase in belly fat noticed? | ☐ No ☐ Yes |
Skin & Hair (Androgen-related)
| Symptom | This Month |
|---|---|
| Acne on face | ☐ None ☐ Mild ☐ Moderate ☐ Severe |
| Acne on chest/back | ☐ None ☐ Mild ☐ Moderate ☐ Severe |
| Acne worse than last month? | ☐ No ☐ Yes |
| Excess facial hair (chin, upper lip) | ☐ None ☐ Mild ☐ Moderate ☐ Significant |
| Excess body hair (chest, abdomen, thighs) | ☐ None ☐ Mild ☐ Moderate ☐ Significant |
| Hair growth worse than last month? | ☐ No ☐ Yes |
| Scalp hair thinning / hair fall | ☐ No ☐ Mild ☐ Noticeable ☐ Significant |
| Oily skin / scalp | ☐ No ☐ Mild ☐ Moderate ☐ Severe |
| Dark patches of skin (neck, underarms, groin) | ☐ No ☐ Yes - Location: _________________ |
Energy & Metabolism
| Symptom | This Month |
|---|---|
| Persistent fatigue / tiredness | ☐ No ☐ Sometimes ☐ Most days |
| Increased hunger / cravings (especially sugar) | ☐ No ☐ Sometimes ☐ Most days |
| Feeling sluggish after meals | ☐ No ☐ Sometimes ☐ Most days |
| Headaches | ☐ No ☐ Occasionally ☐ Frequent |
| Pelvic / lower abdominal pain (non-period) | ☐ No ☐ Yes - Describe: _________________ |
Lifestyle This Month
| Exercise this month | ☐ None ☐ 1-2 days/week ☐ 3-4 days/week ☐ 5+ days/week |
| Diet quality (self-rated) | ☐ Poor ☐ Fair ☐ Good ☐ Excellent |
| Junk food / sugary drinks | ☐ Daily ☐ Often ☐ Rarely ☐ Never |
| Water intake (approx) | _______ litres/day |
| Sleep quality | ☐ Poor ☐ Fair ☐ Good |
| Average sleep per night | _______ hours |
SECTION 3 — MOOD & MENTAL HEALTH SYMPTOMS
(Score each item: 0 = Not at all, 1 = Mild, 2 = Moderate, 3 = Severe)
| Symptom | Score (0-3) | Notes |
|---|---|---|
| Feeling low / sad / hopeless | ☐ 0 ☐ 1 ☐ 2 ☐ 3 | |
| Anxiety / excessive worry | ☐ 0 ☐ 1 ☐ 2 ☐ 3 | |
| Irritability / mood swings | ☐ 0 ☐ 1 ☐ 2 ☐ 3 | |
| Difficulty concentrating / brain fog | ☐ 0 ☐ 1 ☐ 2 ☐ 3 | |
| Loss of motivation | ☐ 0 ☐ 1 ☐ 2 ☐ 3 | |
| Poor self-image / body image concerns | ☐ 0 ☐ 1 ☐ 2 ☐ 3 | |
| Social withdrawal | ☐ 0 ☐ 1 ☐ 2 ☐ 3 | |
| Stress levels this month (overall) | ☐ 0 ☐ 1 ☐ 2 ☐ 3 |
Total Mood Score: _______ / 24
- 0-6: Mild - self-care strategies
- 7-14: Moderate - discuss with doctor
- 15-24: Significant - professional mental health support recommended
SECTION 4 — MEDICATIONS & SUPPLEMENTS
| Medication / Supplement | Dose | Taken regularly? | Side effects noticed? |
|---|---|---|---|
| ☐ Yes ☐ No ☐ Missed some | |||
| ☐ Yes ☐ No ☐ Missed some | |||
| ☐ Yes ☐ No ☐ Missed some |
SECTION 5 — LAB TESTS THIS MONTH (if done)
| Test | Result | Normal Range | Flag |
|---|---|---|---|
| Fasting blood sugar | 70-100 mg/dL | ☐ Normal ☐ Abnormal | |
| HbA1c | < 5.7% | ☐ Normal ☐ Abnormal | |
| Testosterone (total) | 15-70 ng/dL (female) | ☐ Normal ☐ Abnormal | |
| LH / FSH ratio | < 2:1 (normal) | ☐ Normal ☐ Abnormal | |
| Fasting insulin | < 25 µIU/mL | ☐ Normal ☐ Abnormal | |
| Cholesterol / Lipids | ☐ Normal ☐ Abnormal | ||
| TSH (thyroid) | 0.5-4.5 mIU/L | ☐ Normal ☐ Abnormal | |
| Vitamin D | 30-100 ng/mL | ☐ Normal ☐ Abnormal |
SECTION 6 — QUESTIONS FOR MY DOCTOR THIS VISIT
Write down anything you want to ask before you forget:
SECTION 7 — DOCTOR'S NOTES (to be filled at visit)
Date of visit: ___ / ___ / ______
Weight at clinic: _______ kg | BP: _______ / _______ mmHg
Doctor's assessment:
Changes to treatment:
Next follow-up date: ___ / ___ / ______
QUICK REFERENCE — RED FLAGS (See your doctor sooner if you notice:)
- ☐ No period for more than 90 days
- ☐ Sudden severe pelvic pain
- ☐ Very heavy bleeding (soaking more than 1 pad/hour for 2+ hours)
- ☐ Rapid significant weight gain or loss
- ☐ New or worsening dark skin patches (acanthosis nigricans)
- ☐ Persistent mood symptoms affecting daily life
- ☐ Any new symptoms that concern you
Tip: Print one copy per month and keep them in a folder to bring to each appointment. Tracking trends over 3-6 months gives your doctor the clearest picture and helps tailor your treatment.
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