At present, there is no single test that can diagnose PCOS. A medical Doctor will typically evaluate a combination of clinical findings such as signs and symptoms, medical and family history, and a physical exam, as well as laboratory test results to help make a diagnosis. Once diagnosed, we can then work with you to help support your PCOS. If you haven’t had testing done I can also order testing.
Healthcare practitioners will typically diagnose a woman (adult female) as having PCOS if she has at least two of the following features:
- Excess male hormones (androgens)—evidence of this may include a high blood testosterone level, for example, or symptoms such as acne (sometimes severe) and excess hair growth, which can be on the face, stomach and/or back.
- Problems with ovulation—this may include having no menstrual periods, irregular menstrual cycles, or infertility.
- Ultrasound results that show large ovaries with many small follicles that look like cysts (No ultrasound may be needed if a woman has both of the first two features.) You can also have many ‘cysts’ and still have normal hormones, and that’s why an ultrasound test cannot diagnose (or rule out) the hormonal condition PCOS. It simply refers to there being many partially formed follicles on the ovaries, which contain an egg
NOTE: In young teen girls, however, the above criteria are not used to help make a diagnosis because teen girls can often have irregular menstrual periods or missed periods the first two years after starting to menstruate.
Many naturopaths believe that if you don’t have androgen excess, then you don’t have PCOS. That can be true even if you have polycystic ovaries and even if you have irregular periods or no periods. There are lots of reasons for no periods so it is important to find out what is happening with you individually.
PCOS Laboratory Tests
A few blood tests for hormones may be used to aid in the diagnosis of PCOS:
- Testosterone – this is often the initial test to determine whether you are producing excess androgens.
- Sex hormone binding globulin (SHBG) – this may be reduced in PCOS
- Anti-Müllerian hormone (AMH) – an increased level is often seen with PCOS:
- Follicle stimulating hormone (FSH) – will be normal or low with PCOS
- Luteinizing hormone (LH) – will be elevated
- Oestrogens – may be normal or elevated
- DHEAS – may be elevated (indicating potentially adrenal PCOS)
- Androstenedione – may be elevated
- Complete blood count
- Liver enzyme and liver function tests
- Thyroid-stimulating hormone (TSH) – to rule out a thyroid disorder
- Cortisol – to rule out Cushing syndrome and potentially to assess stress/chronic inflammation
- Prolactin – to rule out elevated prolactin (hyperprolactinemia)
- 17-hydroxyprogesterone – to rule out the most common form of congenital adrenal hyperplasia
- Human chorionic gonadotropin (hCG) – to rule out pregnancy
- IGF-1 – to rule out excess growth hormone (which may cause acromegaly)
Insulin Resistance is not a disease or specific diagnosis, but it is common with PCOS. Some testing to check insulin, glucose levels and general health can also be completed.
- Glucose. This is usually performed fasting but, in some cases, a doctor may also order a GTT (glucose tolerance test – several glucose tests that are taken before and at timed intervals after a glucose challenge). The goal of glucose testing is to determine whether a patient has an impaired response to glucose.
- A1c. This test reflects average blood glucose levels over the past 3 months by measuring the percentage or amount of haemoglobin that have been glycated, or bound with glucose, in the bloodstream. It is also called haemoglobin A1c, HbA1c, or a glycohaemoglobin test.
Lipid Profile. This measures the HDL, LDL, triglycerides, and total cholesterol. If the triglycerides are significantly elevated, a DLDL (direct measurement of the LDL) may need to be done.
- Other laboratory tests that may be ordered to help evaluate insulin resistance and provide additional information include:
- Insulin. The fasting insulin test is variable, but insulin levels will usually be elevated in those with significant insulin resistance. Measurement of insulin concentrations during a GTT, sometimes with more frequent sampling, is occasionally also performed.
- hsCRP. This is a measure of low levels of inflammation that may be done as part of an evaluation of cardiac risk. It may be increased with insulin resistance or inflammatory PCOS.
As mentioned above, a pelvic ultrasound (transvaginal and/or pelvic/abdominal) may be used to evaluate the ovaries, to look for cysts and to see if the ovaries are enlarged and whether internal structures appear normal.