Since a limited number of studies have investigated the different pattern of follicular distribution in the ovaries of PCOS patient, the present study was designed to evaluate the relationship of the follicular distribution pattern (FDP) in the ovaries and MetS as well as insulin resistance index, the sex hormones levels and menstrual status in women with PCOS diagnosis. This prospective study was carried out at Arash Women's Hospital (Tehran, Iran) from September 2023 to June 2024. All PCOS women who were referred for any gynecological examination were screened. The ultrasound images of polycystic ovarian morphology ovaries were further classified as having a peripheral cystic pattern (PCP) if the follicles were arranged at the periphery of the ovary, or a general cystic pattern (GCP) if the follicles were dispersed heterogeneously throughout the ovarian stroma. The association between the ultrasound follicular distribution patterns and the reproductive items (menstrual status, sex hormones levels and Ferriman-Gallwey score), as well as the metabolic features (insulin resistance index and the MetS rate) were evaluated. Of the 108 PCOS patients evaluated during the study, 51 patients were classified in the PCP ovaries group and 57 patients in the GCP ovaries group. There was no statistically significant difference in terms of women' age, body mass index, waist circumstance, and the Ferriman-Gallwey score between groups. The frequency of cases with oligo menorrhea in the PCP group was significantly higher than the GCP group (P = 0.006). However, no significant relationship was found between FDP and the baseline serum hormonal levels, total testosterone, and insulin resistance index as well as MetS rate and any components of MetS. No association was identified between the FDP and the rate of MetS, as well as other sex hormones, glucose, and lipids profiles in patients with PCOS
however, the PCP ovaries was linked to menstrual irregularities.