How do you know if you have PCOS?
How is PCOS Diagnosed?
PCOS cannot just be diagnosed on an ultrasound. Contrary to the name “polycystic ovarian syndrome” you do NOT need to have cystic ovaries to be diagnosed with PCOS. In fact, cystic ovaries (with a high ovarian reserve) are a sign of young, healthy ovaries!
Instead, to be properly diagnosed with PCOS you must meet at least 2 out of following 3 criteria:
Absent, Irregular Cycles
Absent cycles means going 3 months without a period if they are typically regular, or 6 months without a period if they are irregular.
Irregular Cycles (Oligomenorrhea) means having only about 6-8 periods a year. Irregular cycles can be a mix of 21-39 day cycles and long 40-120 day cycles. You may be ovulating, not ovulating or not ovulating often.
High Androgens (Testosterone)
Blood tests – Elevated Free, Total Testosterone &/or DHEA-S
Physical Signs of High Androgens like: facial hair (hirsutism), scalp hair loss/hair thinning and acne (typically jaw-line area)
High Blood Sugar or High Inuslin
Tested through Pelvic Ultrasound – the hormonal dysregulation that happens with PCOS can cause many immature eggs (cysts) to try maturing at the same time – showing up as polycystic ovaries
PCOS Lab Testing
You need lab work to be diagnosed with PCOS. Again, ultrasound is not a diagnosis.
Day 3 FSH: – Ideally 4-8IU/L. Follicle Stimulating Hormone. It is a hormone from the brain telling the ovaries to mature an egg for ovulation. If high, the ovaries are having a hard time receiving the message. If low, it would contribute to poor egg development and there may be an issue with the pituitary gland.
Day 3 LH: Ideally 4-8IU/L. Luteinizing Hormone – like FSH, it is released from the pituitary gland. Its purpose is to tell the ovaries to release the matured egg. Ideally it should peak just before ovulation. Some with PCOS have too high LH or LH is trying to peak multiple times, which contributes to high androgens.
FSH:LH ratio: Ideally a 1:1 ratio. With PCOS you may see a 2:1 or 3:1 ratio. A higher ratio can disrupt ovulation
Day 3 Estradiol: Ideally 100-180pmol/L, estradiol causes maturation and release of the egg, and thickening the lining of the uterus for implantation. Low estradiol can indicate PCOS, hypopituitarism, low calorie diet/over exertion, and menopause.
Free/ Total Testosterone: Even a slight increase in testosterone can suppress menstruation & ovulation AND cause significant symptoms.
DHEA- S: An androgen secreted by the adrenal gland. It’s found in all people, but can be elevated in those with PCOS especially if stress is a contributing factor.
Progesterone: – progesterone is made from the matured egg you just ovulated. At 7 days after ovulation, progesterone should be at its highest, Ideally >30 nmol/L. Low progesterone is seen with a small matured egg, low egg quality, or indicates lack of ovulation. Low progesterone makes it difficult to conceive and increases the risk of miscarriage.
Fasting insulin and fasting glucose - the foundation of PCOS is that of “insulin resistance". High levels of insulin in the blood can prevent follicles from maturing and delay ovulation.
If you are suspected to have PCOS, the medical guidelines recommend that you should also be screened for late onset congenital adrenal hyperplasia and thyroid disease. Allcan be screened with these 4 simple blood tests:
17-Hydroxyprogesterone (pre-ovulation)
TSH
TPO, Anti-TG
You should also been screened for the following, as PCOS puts you at risk of the following conditions due to its foundation of insulin resistance:
Type 2 Diabetes
High Cholesterol
High Blood Pressure
Have you had a thorough workup? Naturopathic Doctors can run lab work for you to help get a clearer idea on what is going on hormonally. Book an appointment with us today!
Reference:
