What is PCOS?
PCOS stands for Polycystic Ovarian Syndrome. It is a hormonal imbalance that affects 10-15% of women who are of reproductive age.
This is an important question. The common symptom that women with PCOS have is that they don’t ovulate regularly, and sometimes not at all. Why they don’t ovulate can vary, though. This is where PCOS tests are important to determine the exact cause. Knowing the exact cause, helps me to customize PCOS treatment.
What Tests Should You Have for PCOS?
The following are the blood tests that I would always recommend for any woman who has irregular periods, acne, hair loss, infertility, hirsutism, acanthosis nigricans, and anovulatory cycles to determine the cause.
- DHEAs: DHEAs is a weak male hormone or androgen. If it is too high, it will interfere with the normal function of your ovaries, and it can cause all of the symptoms of PCOS.
- Total testosterone: Testosterone is a stronger androgen. Similar to DHEAs, it will interfere with the normal function of your ovaries, so that you may not ovulate properly, resulting in PCOS symptoms.
- DHT: DHT or dihydrotestosterone is a potent form of testosterone. This test is rarely done, but super important for any woman with signs of PCOS, especially hair loss and acne. Your levels of DHEAs and testosterone may be normal, but DHT can still be too high.
- Prolactin: Prolactin is a hormone that women make to enable breastfeeding. Under certain circumstances, there can be too much in women who are not pregnant or breastfeeding. In this case, it will interfere with the ovaries so that they don’t ovulate correctly.
- TSH, free T3, free T4, anti-TPO, anti-thyroglobulin: These measurements provide a thorough picture of what your thyroid is doing. Most times only TSH is measured to assess your thyroid. This measurement alone is not enough to determine that your thyroid is working perfectly. TSH stands for thyroid-stimulating hormone. It is a hormone produced in a gland in your brain and released into the blood to stimulate your thyroid. In general terms, the better your thyroid is working, the lower the number, the worse it is working the higher the number. But, even when TSH is normal, it may be that your thyroid isn’t working well to convert T4 into T3 (the active form of the hormone). Even when TSH, free T3, and free T4 are all normal, there can still be thyroid antibodies lurking in your system that are damaging your thyroid. I like to see all of the measurements to be completely sure that your thyroid is working normally. Because your thyroid is like the gas pedal for your body, if it is running slowly or poorly, then everything else in your body is sluggish, including your ovaries.
- 7 days after ovulating: progesterone. Progesterone is one of the two main female hormones. It is only produced after you ovulate, if you ovulate. It is essential for a number of reasons. Without enough progesterone, you can’t get pregnant or maintain a pregnancy. Low progesterone is one of the most common causes of infertility and miscarriage. Progesterone is also vitally important for your mood. It is called a neuroactive steroid, meaning that it influences your brain. It helps the receptors for your happy neurotransmitter (serotonin) and your calming neurotransmitter (GABA) to work effectively. Without receptors for these neurotransmitters that work well, you’ll feel depressed or anxious. Two emotions commonly experienced by women with PCOS. Progesterone has to be measured on the correct day of your cycle (one week after ovulating) to provide meaningful information. On that day, I like to see progesterone at about 40-60 nmol/L. If you know that you don’t ovulate, then there is no need to measure it. If you aren’t sure if you ovulate, then tracking your Basal Body Temperature every day is a useful tool to determine if you do and when.
- Day 3 LH, FSH, and estradiol. Estrogen fluctuates considerably throughout your menstrual cycle. It can range anywhere from about 100 pmol/L on the first day of your period, up to about 1500 pmol/L at ovulation. Because of this wide variability, it has to be measured on a specific day in order to understand it. On day 3 of your period estrogen (estradiol) should be about 150-200 pmol/L. At that level, egg follicle development is on track and estradiol is being released normally.
- HOMA-IR. This stands for Homeostatic Model Assessment for Insulin Resistance. This test isn’t a blood test for PCOS per se, it is a calculation based on your fasting glucose and fasting insulin measurements that tell us about insulin resistance. In SI units (mmol/L), it is (fasting glucose in mmol/L x fasting insulin in microU/ml)/22.5.
- Glucose Tolerance Test with Insulin Measurements. This is my preferred test for insulin resistance. It involves going to the lab fasting, and having a fasting blood sugar and fasting insulin measurement done. Then the lab will give you a glucose drink that contains a standard amount of sugar. For this test, it is usually 75 grams of sugar. Blood tests for your blood sugar and insulin measurements are then done 1/2 hour, 1 hour, and 2 hours afterward. What this tells us is how well your body manages a standard dose of sugar and also how much insulin do you have to make to manage that amount of sugar. In my opinion, this is the best way to measure insulin resistance.
- Pelvic and Transvaginal Ultrasound.
Interpreting PCOS Blood Work
Now here’s the really important part, once these tests have been done, they also need to be interpreted properly. Your MD or endocrinologist will rely on “normal” ranges that the lab supplies to them to decide if your numbers are normal or not. Here’s the problem, as a former lab technologist, lab ranges, especially for hormones, are not based on what is optimal or ideal. They are just averages of whomever the lab has tested. In the case of hormones, the lab is often testing people who have an obvious sign of hormone imbalance, such as irregular periods, excessive facial or body hair, hair loss, acne, or fertility problems. So the lab tests these individuals, averages their numbers, throws out the really bad outliers, and then uses this range of “abnormal” people, and calls it a “normal” range. For hormones, this creates ranges that are not at all based on a healthy person and that tend to be wide, and even people with obvious signs of hormone imbalance fall inside the range. The other big problem with lab values for hormones is that estrogen and progesterone vary widely throughout your cycle. This is not to say that they can’t be tested, but that they have to be tested at very specific times in the cycle in order to be able to interpret the resulting numbers. For example, we want to measure day 3 estrogen (estradiol), and 7 days after ovulating progesterone.
If you need help getting blood tests for PCOS, call me at 416-481-0222. I can order all of the tests mentioned, or your MD can as well. If he or she will, then OHIP will pay for the tests, except for DHT. If I order them for you, OHIP will not cover the cost of any of the tests.