Bilateral PCOD: Causes, Symptoms, Diagnosis & Treatment

Introduction

Polycystic ovarian changes commonly show up during ultrasound scans in women of reproductive age. They happen when the follicles in the ovaries fail to develop properly and are seen as small fluid-filled sacs on ultrasound scan^1,2.  

Polycystic Ovarian Disease (PCOD) or Polycystic Ovarian Syndrome (PCOS) are conditions linked to hormonal imbalances, mainly affecting the ovaries, but can also affect other parts of the body¹. Although the terms PCOD and PCOS are commonly used interchangeably, PCOD is a radiographic finding (based on ultrasound scans), while PCOS is the clinically accepted terminology which usually indicates a more severe condition associated with greater hormonal and metabolic disturbances.  

While PCOD and bilateral PCOD seem similar, there is a small difference here. Bilateral PCOD means that both the ovaries show polycystic changes, and unilateral PCOD is when only one ovary is affected³.  

In this blog, we will explain what bilateral PCOD means and how it develops in the body. We will also cover its symptoms, diagnostic methods, and treatment options that can help manage the condition and support better reproductive health. 

What Is Bilateral PCOD?

Polycystic ovary is diagnosed when an ovary has 12 or more small follicles or appears larger than normal (more than 10 cm³) in size as seen on an ultrasound scan. These changes can be seen in one ovary or in both the ovaries⁴. Bilateral PCOD is a term used when polycystic changes are seen in both the ovaries in an ultrasound scan. The word “bilateral” means “both sides”, so it indicates that changes are present in both the ovaries. Therefore, bilateral PCOD is not a separate disease entity but a way of reporting polycystic changes seen in both the ovaries radiographically³. 

Although known as polycystic ovaries, the term ‘cyst’ is misleading as these are not actual cysts but small ovarian follicles that fail to develop. Normally, the follicles in the ovary grow and release an egg during ovulation. But in polycystic ovaries, hormone imbalance stops them from maturing properly, so the ovary may have many small, underdeveloped follicles⁵.  

In bilateral polycystic ovaries, both ovaries may show similar structural changes such as: 

• Enlarged ovaries with multiple small follicles (fluid-filled sacs)² 
• Dense stroma (inner tissue of the ovary getting more compact, solid, or tightly packed)⁶ 

As the follicles don’t develop properly, egg may not be released regularly from the ovaries, affecting the normal menstrual cycle and may even impact fertility, depending on the severity of the condition^1,6. 

Causes of Bilateral PCOD

PCOD or PCOS can develop due to a combination of hormonal, genetic, metabolic, lifestyle, and inflammatory factors that together disrupt normal ovarian function. 

• Insulin Resistance: Women with PCOD develop insulin resistance, which makes the pancreas produce more insulin than normal. This excess insulin then stimulates the ovaries to produce higher levels of androgens (male hormones), which can interfere with regular ovulation⁵. 
• Hormonal Imbalance: Abnormal hormone levels stop the follicles from growing and maturing properly to release eggs. As a result, these immature follicles build up in the ovaries⁵. 
• Genetic Factor: Women who have a mother or sister with PCOD have a higher risk of developing the condition themselves due to shared genetic and hormonal factors². 
• Lifestyle and Diet: Hormonal balance can be affected in women with a sedentary (inactive) lifestyle, high stress, obesity, sleep and poor eating habits thereby increasing the risk of developing PCOD^2,6. 
• Inflammation: Women with chronic inflammation may experience increased production of androgens (male hormones) in the body, which can also disrupt normal metabolic functions. Over time, this can affect overall hormonal balance and metabolic health⁷. 

Symptoms of Bilateral PCOD

Symptoms of Bilateral PCOD may range from being asymptomatic (no symptoms, only ultrasound findings) to having severe symptoms similar to PCOS, including: 

• Irregularity or absence of menstrual cycles 
• Excess hair growth on the face, chest, abdomen, or thighs 
• Weight gain, obesity, or difficulty in losing weight 
• Severe acne that may not go away with treatment 
• Oily skin 
• Dark, thickened patches of skin (acanthosis nigricans) 
• Infertility (not for all, still a common cause in many)¹ 
• Hair thinning (baldness) or hair loss 
• Fatigue or low energy levels 
• Mood changes, such as anxiety, depression, or mood swings² 

Diagnosis of Bilateral PCOD

Bilateral PCOD is a radiographic term (based on ultrasound scan) and does not have a definite diagnostic criterion as per standard guidelines. However, generally along with an ultrasound, your doctor will take a proper medical history and may suggest some blood tests to understand the impact of the condition. 

1. Medical History

Your doctor will discuss your symptoms and do an overall assessment. They may ask for: 

• Your menstrual cycles, whether they are regular or any irregular, infrequent, or missed periods⁵. 
• Associated symptoms such as obesity, acne, oily skin, dark patches on the skin, and thinning hair on the scalp (alopecia)^1,2. 
• Existing conditions like diabetes or prediabetes⁵. 
• Family history of PCOD^1,2. 

2. Hormonal Blood Test

Your doctor might suggest several blood tests to understand whether you have PCOD or are at a risk of developing it¹. She might suggest tests such as: 

• Androgen tests: Measures male hormone levels, which are often elevated in PCOD, causing acne, excess hair growth, or hair thinning. They help confirm hyperandrogenism, a condition were the male hormones (androgens) in the body will be higher than normal levels⁷. 
• Anti-Mullerian hormone (AMH) test: Helps identify high AMH, which is often higher in PCOD due to an increased number of small ovarian follicles⁸. However, this alone cannot diagnose bilateral PCOD. 
• Oral glucose tolerance test (OGTT): Checks how the body processes sugar after drinking glucose. It helps detect early blood sugar problems like prediabetes or insulin resistance and is useful in assessing metabolic health in PCOD⁹. 

3. Ultrasound

Ultrasound findings are important to diagnose Bilateral PCOD. An Ultrasound scan will show multiple follicles in the ovaries through high-frequency sound waves and produces clear images. Their types include: 

• Transabdominal ultrasound: This is done over the stomach and was one of the first methods used to detect PCOD.  
• Transvaginal ultrasound: This is performed through the vagina. It gives clearer and more detailed images of the ovaries than transabdominal ultrasound.  
• 3D-ultrasound: It provides more accurate and objective measurements and can detect more follicles than 2D ultrasound¹⁰. 

Note: The diagnosis of PCOS is based on the Rotterdam criteria⁷ and requires the presence of least 2 of the following 3, irrespective of unilateral or bilateral involvement of ovaries: Oligo or Anovulation (egg may not mature properly or may fail to be released during ovulation), Hyperandrogenism (high levels of male sex hormones), Polycystic Ovarian Changes (seen on ultrasound).  

Treatment of Bilateral PCOD

Treatment for polycystic ovaries focuses on managing symptoms, improving fertility, and avoiding long-term problems. While there is no permanent solution, treatment is personalised to help achieve goals like regular periods, clearer skin, reduced hair growth, and improved chances of pregnancy. 

Treatment options that help manage PCOD and its symptoms: 

• Hormonal Therapy or Birth Control Methods: You might be recommended to take hormonal pills, patch, vaginal ring or a hormone intrauterine device (IUD). The hormonal therapy may help regulate menstruation, reduce the risk for endometrial cancer, and help reduce acne and unwanted facial and body hair^1,11. 
• Insulin-Sensitising Drugs: You might be prescribed insulin-sensitising drugs such as metformin (for type-2 diabetic patients or some patients with insulin resistance). It helps the body use insulin better and lowers blood sugar, insulin, and androgen levels. It may help restore ovulation after a few months but usually has little effect on acne or excess hair. However, it is not approved by the Food and Drug Administration (FDA) to particularly treat PCOD^1,11. 
• Anti-Androgen Drugs: You might be suggested to take anti-androgen medicines, which block the effect of male hormone androgen and can help reduce symptoms such as hair loss, unwanted hair growth, and acne. However, these are not recommended by FDA for treating PCOD or bilateral PCOD^1,11. These medicines are recommended to be taken along with contraceptives, as they may cause birth defects in a developing baby (teratogenicity). 
• Cosmetic and dermatological treatments: Your cosmetologist might suggest methods like laser hair removal, electrolysis, and topical treatments to manage symptoms like unwanted hair and acne. These can improve physical appearance and quality of life^1,11. 
• Management of Metabolic Complications: Your doctor might suggest regular monitoring and treatment of conditions like diabetes, high cholesterol, and hypertension. This helps reduce long-term health risks associated with PCOD¹. 

Treatment options if you want to get pregnant while having polycystic ovaries: 

• Fertility Medicines: Your doctor might prescribe you fertility medicines once the infertility problem is confirmed. He might give you medicines like clomiphene, which help you in ovulation¹¹. 
• Surgery: Your doctor might recommend surgery in very rare cases where medicines like clomiphene fail to induce ovulation. The surgery includes drilling ovaries, as the outer layer of the ovary becomes thick and may restrict normal egg release. The doctor makes small holes in the ovary using heat or a laser to help restore ovulation¹¹. 
• In vitro Fertilisation: Your doctor might prescribe IVF if medicines do not work. In this process, the egg is fertilised in a lab and then placed in the uterus, giving higher chances of pregnancy. 

Note: All the tests and treatments mentioned in this section should only be carried out under the guidance of a qualified gynaecologist and cosmetologist. Self-medication is not recommended. Ignoring professional advice and taking over-the-counter medicines may not provide benefits and can also negatively affect your health. 

Home Remedies for Bilateral PCOD

The following are some home remedies that may help in managing polycystic ovaries symptoms and improving overall hormonal balance. 

• Diet
  • Follow a healthy, balanced diet to help manage symptoms like irregular periods and weight gain². Focus on whole grains, fruits, vegetables, and lean proteins. 
  •  Limit sugary and processed foods (may contain endocrine-disrupting chemicals affecting hormones) to support hormone balance¹². 
• Weight Management: Try losing weight. Losing even a small amount of weight, if you are overweight, can greatly help reduce symptoms, improve fertility, and lower the risk of complications². 
• Physical Activity: Perform regular exercise. This helps your body use insulin more effectively, which can reduce the effects of PCOS². 
• Stress Management: Involve in stress management techniques such as meditation, deep breathing, and yoga. These may help reduce anxiety and depression and ease stress¹³. 
• Proper Sleep: Get proper sleep for at least 6-8 hours, as it is essential for maintaining hormonal balance. Poor sleep can worsen insulin resistance and increase the severity of PCOD symptoms¹⁴. 
• Natural Supplements: Some herbal remedies like cinnamon, curcumin, sage, fennel, and traditional Chinese medicines may help support PCOS management by improving blood sugar control, reducing inflammation, and helping regulate menstrual cycles¹⁵. However, evidence regarding these supplements are limited and inconsistent, and their effectiveness is still not well established. Please confirm with your doctor if you are planning to start herbal supplementation for PCOD to avoid adverse effects due to them. 

Note: Although home care measures can help manage the symptoms of polycystic ovaries, they should not replace proper medical treatment. Always consult your doctor before attempting weight loss or using herbal supplements. These remedies should be used alongside prescribed treatment, not as a substitute. Consult a doctor if the symptoms get worse. 

When to Consult a Doctor?

The following are some symptoms you should not ignore, whether or not you have bilateral PCOD. 

• Irregular, missed, or absent menstrual periods 
• Excess facial or body hair, severe acne, or hair thinning 
• Unexplained weight gain or difficulty losing weight² 
• Difficulty in conceiving or infertility issues 
• Darkening of skin¹¹ 
• Persistent fatigue or low energy levels 
• Mood changes such as anxiety, depression, or mood swings² 
• Worsening of PCOD-related symptoms  
• Planning to get pregnant¹¹ 
• Signs of high blood sugar (increased thirst, frequent urination) 

If you have already been diagnosed with bilateral PCOD, it is important to regularly monitor your symptoms. Even if you are not diagnosed but experience similar symptoms, consult your doctor for proper evaluation and guidance. 

Also Read: PCOS Diet: How to Use Food to Help Manage Your PCOS

Conclusion

Now you might be clear with the bilateral PCOD meaning; it is caused when both ovaries are affected by changes caused by a hormone imbalance. While it may cause symptoms like irregular periods, weight changes, and skin issues, it can be managed effectively with proper treatment and lifestyle changes. Early diagnosis and regular medical guidance play an important role in avoiding complications. With the right care, many women can maintain good reproductive and overall health. 

Frequently Asked Questions (FAQs)

References

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3. Leelamma J, Pillai MT, S A, Nambisan B, Nambiar R. Comparison between unilateral and bilateral polycystic ovaries in adolescent PCOS. Scholars Journal of Applied Medical Sciences (SJAMS). 5(6):2472-2477. Doi: https://www.saspublishers.com/article/14089/download/ 

4. Christ JP, Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics. 2023;13(6):1113. doi:10.3390/diagnostics13061113. https://pubmed.ncbi.nlm.nih.gov/36980421/ 

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8. Anti-Müllerian Hormone Test. 2023. Doi: https://medlineplus.gov/lab-tests/anti-mullerian-hormone-test/ 

9. Prosperi S, Chiarelli F. Insulin resistance, metabolic syndrome and polycystic ovaries: an intriguing conundrum. Front Endocrinol. 2025;16:1669716. doi:10.3389/fendo.2025.1669716. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2025.1669716/full 

10. Di Michele S, Fulghesu AM, Pittui E, et al. Ultrasound Assessment in Polycystic Ovary Syndrome Diagnosis: From Origins to Future Perspectives—A Comprehensive Review. Biomedicines. 2025;13(2):453. doi:10.3390/biomedicines13020453. https://pubmed.ncbi.nlm.nih.gov/40002866/ 

11. Polycystic ovary syndrome: OASH. 2025. Doi: https://womenshealth.gov/a-z-topics/polycystic-ovary-syndrome 

12. Paramasivam A, Murugan R, Jeraud M, Dakkumadugula A, Periyasamy R, Arjunan S. Additives in Processed Foods as a Potential Source of Endocrine-Disrupting Chemicals: A Review. JoX. 2024;14(4):1697-1710. doi:10.3390/jox14040090. https://pubmed.ncbi.nlm.nih.gov/39584955/ 

13. Rao V, Pena A, James A, et al. The role of meditation and mindfulness in the management of polycystic ovary syndrome: a scoping review. Front Endocrinol. 2024;15:1295705. doi:10.3389/fendo.2024.1295705. https://pubmed.ncbi.nlm.nih.gov/38818503/ 

14. Goodarzi L, Ahmadi MM, Ramezanirad M, et al. The Role of Sleep Hygiene in Different Patterns of Polycystic Ovary Syndrome (PCOS): Insights from Modern and Persian Medicine. MJIRI. Published online February 25, 2025. doi:10.47176/mjiri.39.116. https://pmc.ncbi.nlm.nih.gov/articles/PMC12584089/ 

15. Muhammed Saeed AA, Noreen S, Awlqadr FH, et al. Nutritional and herbal interventions for polycystic ovary syndrome (PCOS): a comprehensive review of dietary approaches, macronutrient impact, and herbal medicine in management. J Health Popul Nutr. 2025;44(1):143. doi:10.1186/s41043-025-00899-y. https://pubmed.ncbi.nlm.nih.gov/40317096/ 

16. Bassette E, Ducie JA. Endometrial Cancer in Reproductive-Aged Females: Etiology and Pathogenesis. Biomedicines. 2024;12(4):886. doi:10.3390/biomedicines12040886. https://pubmed.ncbi.nlm.nih.gov/38672240/ 

17. Polycystic Ovary Syndrome (PCOS) Blog. 2024. Doi: https://www.fda.gov/consumers/knowledge-and-news-women-owh-blog/polycystic-ovary-syndrome-pcos-blog 

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