You have the irregular periods, stubborn acne, the hair in places it should not be, and thinning where it should. You pushed for a scan, and were told that everything looks normal.
For a lot of women, that’s where the conversation ends, with no diagnosis, no answers, and the suggestion that perhaps you are making too much of it. But a normal ultrasound doesn’t mean nothing is wrong. Here’s what might actually be going on.
First, an important update: PCOS is now PMOS
In May 2026, after more than a decade of work involving patients, doctors, and researchers worldwide, Polycystic Ovary Syndrome (PCOS) was officially renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS). The change was published in The Lancet and backed by 56 organisations globally.
The old name was always a bit misleading because it put cysts front and centre, when they were never really the main issue. The new name better reflects what the condition actually is: a hormonal and metabolic disorder that affects the whole body, not just the ovaries. You will still see PCOS used for a while as things transition, and if you were previously diagnosed with it, nothing has changed – it’s the same condition with a more accurate name.
Can you have PMOS without cysts on a scan?
Yes, and this is probably the most important thing to know if you’ve been told your scan is clear.
PMOS is diagnosed using something called the Rotterdam Criteria. At The Gynae Centre, we use these criteria, which only require two of the following three things to be present:
1. Irregular or absent periods
2. Higher than normal androgen levels – either picked up on a blood test (raised testosterone) or showing up as symptoms like excess facial or body hair
3. The appearance of polycystic ovaries on an ultrasound scan
Two out of three. That’s all it takes. So if your periods are all over the place and your testosterone is raised, the scan result does not actually matter as a diagnosis can still be made without it. Not having cysts on a scan doesn’t rule PMOS out.
If PMOS is confirmed, we’ll also check your cholesterol levels and run a blood test called HbA1c to look at your blood sugar over time. This is because PMOS often has a metabolic side that is worth catching early.
What PMOS looks like when the scan is clear
When the scan comes back normal, it’s easy for symptoms to get written off as separate issues, perhaps a skin problem, stress, or maybe your thyroid. But the symptoms of PMOS are driven by hormones, not by what shows up on an ultrasound. They can be very real and very disruptive even when the ovaries look completely fine on a scan.
Women with PMOS who have no visible changes on ultrasound can still have irregular or unpredictable periods, excess hair on the face or body, persistent acne (especially around the jaw and chin) hair thinning at the crown, difficulty losing weight, and fatigue or low mood that seems out of proportion to everything else going on.
These are not a handful of unconnected problems. They’re mostly driven by the same thing: higher androgen levels than the body needs, and it shows up in different ways. Putting them down to separate causes because the scan looked fine is not a reassurance; it’s a missed diagnosis.
Why a scan can miss it
There are a few reasons an ultrasound might not pick up anything, even in someone who does have PMOS.
- Timing matters a lot: The ovaries look different at different points in the menstrual cycle, and a scan done at the wrong time might not show anything unusual. For women with irregular cycles, getting the timing right is even trickier.
- How the scan is reported also plays a part: The guidelines for what counts as a positive finding have been updated over the years, and older criteria are more conservative. Something that would be flagged now might have been missed a few years ago.
- And then there is the name problem: Calling this condition polycystic ovary syndrome for decades made everyone, patients and doctors included, assume that cysts were part of the deal. They were not. That is one of the main reasons the name has finally been changed.
Who gets missed most often
Some women are more likely than others to come away without answers, even when PMOS is the cause.
Women with a normal BMI are a well-known blind spot. PMOS affects women of all shapes and sizes, but when someone does not fit the expected picture, symptoms tend to get explained away as something else.
Women of South Asian heritage face a higher risk of being missed too. The metabolic side of PMOS, things like insulin resistance, can develop at a lower body weight than would usually prompt concern in a typical Western clinical setting. Verity UK, the UK’s only PMOS charity, has highlighted that women from certain ethnic backgrounds are more likely to experience delays in diagnosis, and that symptoms can sometimes look a little different too.
Women whose main symptoms are hormonal, like irregular periods, raised testosterone, but nothing obvious on a scan, are also the group most likely to slip through. They are the ones most often told their results are normal and left to get on with it.
What to do if this sounds like you
Dr Alex Eskander, Consultant Gynaecologist at The Gynae Centre, explains: “We see many patients who have been told their scan is normal and taken that to mean they cannot have PMOS. But the Rotterdam Criteria exist precisely because the condition is about so much more than what a scan can show. Raised testosterone and irregular cycles are enough to make the diagnosis – and without it, women are left managing symptoms with no understanding of what is causing them or what the longer-term picture might look like.”
If your symptoms point towards PMOS but you’ve been told your scan is fine, it’s worth getting a proper assessment that looks at the whole picture, including your hormone levels, your cycle history, your blood sugar and cholesterol. A normal scan result isn’t the end of the road; it just means you haven’t had the right tests yet.
At The Gynae Centre, our consultants are specialists in exactly this kind of presentation. We see women who have been dismissed elsewhere, who have spent months or years trying to make sense of symptoms that don’t add up, and we take that seriously.
Appointments are available quickly, with no long waiting lists, and you’ll leave with a clear understanding of what is going on and what comes next, whether that’s treatment, further investigation, or simply the reassurance of finally knowing.
Book a consultation at The Gynae Centre or call us on 020 7580 8090 to speak to the team.
