Essential Blood Tests for PCOS: What You Need To Know
Polycystic Ovary Syndrome (PCOS) is a complex hormonal disorder that affects millions of women worldwide, making it the most prevalent endocrine disorder.
However, diagnosing PCOS isn't as straightforward as one might think. Unlike many conditions with definitive tests, PCOS diagnosis relies on a comprehensive evaluation of symptoms, physical examination, and diagnostic criteria like the Rotterdam criteria.
Blood tests play a crucial role in confirming a PCOS diagnosis and guiding treatment decisions.
These tests provide important insights into hormonal issues and metabolic dysfunctions associated with PCOS. But how exactly do these blood tests contribute to understanding PCOS?
In this blog post, I will dive into the essential blood tests used in diagnosing PCOS. By understanding what each test reveals and what it means in a PCOS diagnosis, you'll gain valuable insights into your health.
So, let's dive in!
Understanding PCOS: A Brief Overview
Polycystic Ovary Syndrome (PCOS) is a multifaceted hormonal disorder characterised by a combination of symptoms such as irregular menstrual cycles, excess androgen levels (male hormones), and polycystic ovaries.
It affects approximately 1 in 10 women of childbearing age worldwide, making it one of the most prevalent endocrine disorders. However, due to variations in symptom presentation and diagnostic criteria, up to 75% of women remain undiagnosed.
Individuals with PCOS often face many challenges, both physical and emotional. Beyond the commonly known symptoms like irregular periods and hirsutism (excessive hair growth), PCOS can also manifest as acne, weight gain, and infertility. These symptoms can significantly impact quality of life, leading to emotional distress, body image issues, anxiety, and depression.
One of the most pressing issues in PCOS diagnosis is the considerable delay that many individuals experience before receiving a formal diagnosis. On average, it can take up to 2 years and visit three or more health professionals before a diagnosis is confirmed.
This delay can be attributed to several factors, including the complexity of symptom presentation, lack of awareness among healthcare providers, and the absence of a single diagnostic test for PCOS.
Early diagnosis of PCOS is paramount for effective management and treatment. By addressing PCOS early on, individuals can better manage symptoms, optimise fertility outcomes, and reduce the risk of associated conditions such as type 2 diabetes and cardiovascular disease.
If you want to learn more about PCOS check out this blog post here.
Different Types of Blood Tests Used in PCOS Diagnosis
Several types of blood tests are commonly used to diagnose PCOS, each providing unique insights into different aspects of PCOS and allowing for monitoring of treatment effectiveness over time. Here are the common blood tests associated with PCOS:
Androgen Levels: Testosterone and DHEAS
Androgens are a group of hormones that play a crucial role in both men's and women's health. Two important androgens that can contribute to your PCOS are testosterone and dehydroepiandrosterone sulfate (DHEAS). When levels of these hormones are out of range they can contribute to symptoms of PCOS, like excessive hair growth, acne, and irregular periods.
Testosterone Levels
Testosterone is a hormone found in both men and women. In women, it's produced in small amounts by the ovaries and adrenal glands, and its production is controlled by another hormone called LH. Testosterone can be converted into oestradiol, the main sex hormone in women.
In women with PCOS, high levels of testosterone can cause symptoms like excessive hair growth, acne, irregular periods, and infertility.
When you get your testosterone levels tested, it's best to fast and have your blood drawn in the early morning for the most accurate results. Keep in mind that normal testosterone levels can vary based on factors like age, sex, and the lab doing the test.
DHEAS
The DHEAS test measures the amount of a hormone called dehydroepiandrosterone sulfate in your blood. DHEAS also gets converted to testosterone. Measuring DHEAS levels can help figure out why there might be too much body hair growth or the development of masculine features in women.
Other important blood tests for PCOS:
In addition to testosterone and DHEAS, several other key blood tests help in diagnosing and managing PCOS. These include follicle-stimulating hormone (FSH), luteinising hormone (LH), anti-Müllerian hormone (AMH), progesterone, estradiol, and sex hormone-binding globulin (SHBG).
Follicle-stimulating hormone (FSH)
FSH, or follicle-stimulating hormone, is key in the menstrual cycle and egg production. FSH levels change throughout your cycle and peak just before you ovulate (when an egg is released). We use FSH testing to check for fertility issues and irregular menstrual periods.
If you have PCOS, your doctor will likely test your FSH along with LH, testosterone, estradiol, and progesterone to understand your symptoms better. High FSH levels can signal problems with the ovaries, while low levels might indicate issues with the pituitary gland or hypothalamus.
Note: Some medications can affect FSH levels. For example, medications like clomiphene, naloxone, and cimetidine can raise FSH levels, while oral contraceptives, phenothiazines, and hormone treatments can lower them.
Luteinising Hormone (LH)
LH, or luteinising hormone, works closely with FSH and is also produced by the pituitary gland in the brain. Mid-cycle, LH levels rise to trigger the release of an egg. LH also helps the ovaries produce estradiol and progesterone.
In women with PCOS, high levels of both FSH and LH can prevent regular egg release during the menstrual cycle. When this happens repeatedly, it’s called chronic anovulation, leading to irregular periods, fertility issues, and hormonal imbalances often seen in PCOS.
Note: LH is released in pulses, so its levels can fluctuate. A single test might not give a complete picture, so multiple tests over time might be needed to understand LH levels better.
PCOS is often associated with a high LH/FSH ratio. A ratio higher than 2:1 is often a sign of PCOS.
Progesterone
Progesterone is a hormone that plays a crucial role in a woman's menstrual cycle, particularly in preparing the body for a possible pregnancy. Each month, estrogen prompts the lining of the womb to grow back. Simultaneously, luteinising hormone (LH) helps release an egg from the ovary.
After ovulation, a group of cells called the corpus luteum forms in the ovary and begins producing progesterone. This hormone slows down the growth of the womb lining and prepares the uterus for a fertilized egg to implant.
Because progesterone levels fluctuate throughout the menstrual cycle, we can measure it multiple times to understand fertility issues.
Testing progesterone levels helps determine if ovulation has occurred and when it happened. It also helps assess the effectiveness of treatments aimed at improving ovulation.
Estradiol
Estradiol is a type of estrogen hormone that's important for your menstrual cycle and reproductive health. When your body is getting ready to release an egg, follicle-stimulating hormone (FSH) makes the follicles around the egg produce oestradiol.
Once the oestradiol levels reach a certain point, LH is released, which triggers the egg's release and prepares the body for possible fertilization.
In PCOS, changes in estrogen levels can lead to irregular periods, trouble getting pregnant, and other symptoms. By checking oestradiol levels, doctors can understand how well your ovaries are working and determine why you might not get your period.
It's important to know that estradiol levels can change a lot during your cycle, so your doctor will monitor them over time to see how they're changing.
Anti-Mullerian Hormone (AMH)
AMH is a hormone that helps us know how many eggs a woman has. Lower levels of AMH mean there are fewer eggs left.
As women get older, AMH levels naturally go down, and so does the number of eggs, which can make it harder to get pregnant.
In conditions like polycystic ovary syndrome (PCOS), AMH levels can be higher because there are more small egg sacs in the ovaries.
Studies have found that women with PCOS may have AMH levels up to four times higher than what's normal for their age.
Normal AMH levels can vary based on age and sex, as well as the lab where the test was done.
Sex Hormone-Binding Globulin (SHBG)
SHBG is a protein made by your liver, and how much of it you have in your blood depends on things like your age, sex, and hormone levels. It can also be influenced by conditions like liver disease, thyroid problems, and obesity.
When your doctor orders an SHBG test, they're mostly checking on your androgen hormones (often called male hormones).
In women, even small increases in androgen hormones like testosterone can cause issues like missed periods, trouble getting pregnant, acne, and excess hair growth, which are common in polycystic ovary syndrome (PCOS).
SHBG acts like a carrier for hormones, including testosterone, making them less active in the body.
So, if SHBG levels are low, more testosterone is free to cause these symptoms. Low SHBG levels are often found in PCOS, where they're linked to another problem called insulin resistance.
Knowing your SHBG levels helps your doctor understand how much active testosterone you have.
This information guides treatment decisions. For example, if SHBG levels are low, your doctor may suggest treatments to improve insulin resistance, which can raise SHBG levels.
Testing SHBG levels is an important part of managing PCOS and finding the right treatment for you.
Understanding Metabolic Testing in PCOS
In addition to hormonal imbalances, polycystic ovary syndrome (PCOS) is often associated with metabolic issues, such as insulin resistance and glucose intolerance.
To better understand these metabolic aspects of PCOS and guide treatment strategies, your doctor may order tests to assess fasting glucose, fasting insulin, haemoglobin A1C (HbA1C) and The Oral Glucose Tolerance Test (OGTT).
These tests provide valuable insights into how the body handles sugar and insulin, helping to identify individuals at risk of developing type 2 diabetes and guiding interventions to improve metabolic health in PCOS patients.
Fasting Glucose
Glucose is a type of sugar that gives our bodies energy. When we eat carbohydrates like bread or pasta, our bodies break them down into glucose, which is then used by our cells for fuel.
Our bodies need a hormone called insulin to help the cells use glucose properly. Insulin acts like a key, unlocking the cells so glucose can enter and provide energy.
Normally, our blood sugar levels rise a little after eating, and insulin helps bring them back down. But if blood sugar levels get too high or too low over consistently, it can cause problems.
Your doctor might check your fasting glucose levels, which means they test your blood sugar after you haven't eaten for about 8 to 12 hours.
This helps them see if your body is handling glucose properly, especially if they're worried about conditions like diabetes that are linked to PCOS.
If your fasting glucose levels are too high, it could mean your body isn't using insulin well, which might lead to diabetes. If they're too low, it could be a sign of hypoglycemia.
Fasting blood glucose levels are measured to see how much sugar is in your blood after not eating for about 8 to 12 hours. Here are the different ranges and what they mean:
Normal Glucose Tolerance: This means your blood sugar levels are healthy. The range is between 3.0 and 6.0 mmol/L.
Impaired Fasting Glucose: If your blood sugar levels are between 6.1 and 6.9 mmol/L, it could mean you have impaired fasting glucose. This is a warning sign that you're at risk of developing diabetes.
Probable Diabetes: If your blood sugar levels are 7.0 mmol/L or higher, it's likely that you have diabetes.
Your doctor will use these numbers to help understand your PCOS and decide on the best treatment for you.
Fasting Insulin
Insulin is a hormone made by the pancreas that helps regulate the amount of sugar in your blood. After you eat, your blood sugar levels go up, and insulin is released to help move the sugar into your cells, where it's used for energy.
In people with type 1 diabetes, the pancreas doesn't make enough insulin, so they need to take insulin injections to control their blood sugar levels. In type 2 diabetes, the body might make enough insulin, but it doesn't work as well as it should.
Doctors might check your fasting insulin levels, after you haven't eaten for about 8 hours, to see how well your body is responding to insulin. If your levels are too high, it could be a sign of insulin resistance.
Reference interval: 4-10 mU/L after 8hr fast
Hemoglobin A1C
Hemoglobin A1C (HbA1C) is a blood test used to check for type 2 diabetes and see how well your blood sugar has been controlled over the past few months. It gives your doctor an idea of your average blood sugar levels during that time.
Here are the different ranges and what they mean:
Less than 6% (42 mmol/mol): This means diabetes is unlikely.
Between 6.0 and 6.4% (42 - 46 mmol/mol): This is considered prediabetes. It's a warning sign that your blood sugar levels are higher than normal and you're at risk of developing diabetes.
6.5% (48 mmol/mol) or higher: This suggests diabetes, but it may need to be confirmed with another test.
Since insulin resistance is a common feature of PCOS, monitoring HbA1c levels can provide valuable information about long-term blood sugar control.
Elevated HbA1c levels may indicate impaired glucose metabolism, which could increase the risk of developing type 2 diabetes in individuals with PCOS.
Oral Glucose Tolerance Test (GTT)
The Oral Glucose Tolerance Test (OGTT) is a diagnostic test used to assess how your body processes glucose.
During an OGTT, your blood glucose levels are measured after fasting for 8 to 12 hours.
Then, you'll drink a glucose drink, and your blood glucose levels will be measured again one and two hours later.
This test helps your doctor understand how your body responds to a glucose challenge and can help diagnose diabetes or prediabetes.
The OGTT is used in diagnosing gestational diabetes in pregnant women.
Here's what the results mean in non-pregnant women 2hrs after a 75g glucose drink:
Normal glucose tolerance: If your blood glucose levels are between 3.0 and 7.7 mmol/L after the test, it suggests that your body is effectively processing glucose, and diabetes is unlikely.
Impaired fasting glucose: If your blood glucose levels are between 7.8 and 11.0 mmol/L, it may indicate impaired glucose metabolism, which is a precursor to diabetes.
Probable diabetes: If your blood glucose levels are equal to or more than 11.1 mmol/L, it suggests that you may have diabetes, but further testing may be needed to confirm the diagnosis.
Additional Testing:
In the diagnostic journey of Polycystic Ovary Syndrome (PCOS), attention to metabolic health goes beyond the reproductive system.
Suspected cases of PCOS often prompt doctors to investigate thyroid function and lipid profiles. These additional tests offer valuable insights into metabolic health and cardiovascular risk factors, which are closely intertwined with PCOS.
Thyroid function tests
Your doctor may complete a thyroid panel because thyroid dysfunction can often be mistaken for PCOS and remember getting a PCOS diagnosis is ruling out other conditions first.
Testing may include:
TSH
T4 or FT4
FT3 or rT3
Thyroid Antibodies
Lipid Profile
In addition to thyroid function tests, your doctor may recommend lipid profile testing for individuals with suspected PCOS.
Understanding lipid levels is essential as individuals with PCOS may have an increased risk of dyslipidemia, characterised by abnormal lipid levels, which can contribute to cardiovascular disease risk.
Testing may include:
Total cholesterol
HDL (high-density lipoprotein)
LDL (low-density lipoprotein)
Triglycerides
I'll be delving into these tests more thoroughly in future blog posts, so stay tuned for detailed insights into their significance and implications for PCOS.
Vitamin D
Vitamin D is a fat-soluble vitamin essential for maintaining bone health, immune function, and overall health. It plays a crucial role in calcium absorption, promoting bone growth and remodelling.
Without sufficient vitamin D, bones can become thin and brittle. For women with PCOS Vitamin D helps improve insulin resistance and menstrual regularity.
Deficiencies can cause a range of health problems and risks so it’s important to have your levels checked.
B12
Vitamin B12 is a water-soluble vitamin that plays a vital role in various bodily functions, including the production of red blood cells, DNA synthesis, and the proper functioning of the nervous system.
It is one of the eight B vitamins, each of which has unique functions but often works together to support overall health.
Deficiencies can lead to fatigue, weakness, memory problems, and digestive issues. Vegetarians and Vegans are most at risk of deficiency because B12 is primarily found in animal products so it is recommended to take a supplement.
Iron Studies
Are a group of blood tests that assess the levels of iron in the body and provide important information about how iron is being utilised and stored.
These tests are commonly used to diagnose and monitor conditions related to iron deficiency, iron overload, and other disorders affecting iron metabolism.
Testing may include:
Serum Iron
Total Iron-Binding Capacity (TIBC)
Transferrin Saturation
Ferritin
Please note I'll be delving into these tests more thoroughly in future blog posts, so stay tuned for detailed insights into their significance and implications for PCOS.
Questions to Ask When Discussing Blood Test Results with Your doctor:
Understanding the Results:
What do my blood test results indicate about my PCOS?
Can you explain the significance of the levels of [specific hormone or marker] in my results?
Treatment Options:
Based on my blood test results, what treatment options do you recommend?
Are there lifestyle changes or medications that can specifically address what was revealed in my blood tests?
Long-Term Management:
How will these interventions impact my overall health and long-term management of PCOS?
What is the expected timeline for observing improvements based on my blood test results?
Potential Complications:
Are there any potential complications or risks associated with the imbalances identified in my blood tests?
How will we monitor and address these concerns over time?
Follow-up and Monitoring:
How frequently should I have follow-up blood tests to track progress?
What signs or symptoms should I monitor between appointments?
Remember, PCOS is a complex condition, but with early diagnosis, personalised treatment plans, and ongoing support, managing its symptoms and optimizing long-term health outcomes becomes not only achievable but also empowering.
And let's not forget the critical role that blood tests play in this journey. By understanding the insights they provide and actively engaging with your healthcare team, you can take charge of your health and manage your PCOS effectively.
Any questions please leave a comment below!
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