Lab Tests to request when you think you may have PCOS

The word is out more than ever about Polycystic Ovarian Syndrome and for good reason with it being the most common chronic illness in women of reproductive years. You may have heard about it online or from a friend but how do you know if you have it? PCOS is diagnosed using what is called the Rotterdam Criteria and you basically need 2 out of the 3 criteria for a diagnosis. Here are the 3 criteria: 1. Symptoms of high androgens (hair loss, abnormal hair growth, weight gain, acne, irregular or absent menstrual cycles) 2. High androgens based on lab work (testosterone, mainly, but also DHEA) 3. Multiple ovarian cysts seen with an ultrasound. Even with elevated androgens, you may not have a lot of the symptoms. It’s possible you’re just having irregular cycles or you have regular cycles but you have acne. Regardless of what the constellation of symptoms you are experiencing are, if you’re having any of those symptoms or even none at all but you’re having trouble conceiving, it’s worth asking your doctor to run some tests. If your doctor refuses, as many of my clients have experienced, find a new doctor that will listen to you and trust your experience. Here are the tests worth getting if you want to see if you have PCOS:

Free Testosterone

Testosterone is an androgen in your body that may be elevated with PCOS. It is, at least in part, responsible for the acne and male-pattern hair loss that is often seen in PCOS. While we think of testosterone as mainly a hormone in men, women do need it to feel balanced but at lower levels. Elevated testosterone, along with symptoms of PCOS or the presence of ovarian cysts is diagnostic for the condition. 

Progesterone

Testing progesterone on day 21 of your cycle can indicate if you’ve ovulated or not. I want to see progesterone at least 20ng/ml for optimal health. If you’re not having a period, then you aren’t ovulating at all. Low progesterone is very common in PCOS and is often a result of not ovulating. Progesterone below 3ng/ml is a sign that ovulation hasn’t happened. Diet and lifestyle, as well as herbs and homeopathy, can be very helpful in restoring ovulation and regulating your period.

Thyroid Panel (TSH, Free T3, Free T4, TPO, RT3)

The ovaries are very closely related to the health of your thyroid and it's common for thyroid hormones to be out of balance in PCOS. Recognizing the need to address both the health of the ovaries and the thyroid to start successfully reversing this condition is an important part of your care. 

LH/FSH

LH stands for luteinizing hormone and is elevated in 75% of cases of PCOS. FSH stands for follicle stimulating hormone and it is often low when experiencing PCOS. The ratio of these two hormones together is elevated in 94% of PCOS cases so it can be very helpful to see the full picture of where your hormones are currently.

Fasting Insulin and Fasting Glucose 

Insulin Resistance (IR) often accompanies PCOS and can be significant when weight gain is one of your symptoms. These two tests can indicate your blood sugar levels and the insulin response and can help individualize dietary recommendations to stabilize blood sugar.   

BONUS: Transvaginal Ultrasound (TVUS)

An ultrasound can show if cysts are present on your ovaries. They are present in a majority of PCOS cases and would be worth performing particularly if you are experiencing difficulty conceiving and are without symptoms of PCOS. Some women do have multiple cysts and blood work out of range without symptoms. This is definitely more rare but worth ruling out if you’ve been trying to get pregnant for some time. 

I also often like to see results from cortisol testing to see how your circadian rhythm and stress response is doing. The health of your adrenals, and really your entire hypothalamic-pituitary-adrenal axis (basically the communication from your brain to your adrenals), has so much to do with whether your body is effectively signaling you to ovulate and have regular periods. 

Finally, if you do end up being diagnosed with PCOS, know there is so much more to be done to reverse your PCOS beyond getting on birth control pills. When the underlying cause of your PCOS is addressed, you can actually start to heal rather than just addressing the symptoms. 

If you’re interested in learning more about my approach, book a 15 minute discovery call now. 

You Are Mean't to Bleed: Thoughts on Getting your Period

While it’s without a doubt more convenient to skip you period or bleed very lightly, the female body was designed to release (literally and energetically) each month, with the exception of pregnancy or menopause.

Even in my practice I see many women who do “really well” on hormonal birth control, meaning they don’t experience the classic crazy, or the weight gain, or the headaches, etc. but they are still coming to see me for a reason that seems unrelated but often actually isn’t.

The birth control pill affects your nutrient status, specifically b-vitamins, zinc and magnesium (all, so important). It also affects your microbiome and gut health, which plays such a huge role in neurotransmitter production. That means it can affect your mood, mental clarity and general sense of wellbeing. It’s also worth noting that a fairly recent research study published in the New England Journal of Medicine demonstrated and increase in breast cancer risk regardless of whether hormones were being delivered via pill, patch, implant, ring or IUD. That’s serious business.

Also, beyond the physical effects of hormonal birth control and the lack of period that often comes with it, the act of bleeding each month is a sacred ritual. It is an internal rhythm of your incredible, feminine, wild self that mimics the perfect rhythm of the environment in which you belong. If you’ve been hesitant to embrace this truth, take a moment to reflect on why that is the case. What have you been told about bleeding or being a woman? Is there some part of yourself that you’ve been neglecting that need nurturing? Is there a story that you’re ready to let go of in order to reclaim this part of being a woman?

I love helping find non-hormonal forms of contraception that works for you and if you’re taking the pill to manage other symptoms, like acne, painful or irregular periods, endometriosis, etc then it’s probably time to do the work to understand why you’re experiencing those symptoms. Conventional medicine doesn’t have great ways of addressing those symptoms besides the pill but naturopathic, Chinese medicine & functional medicine does. If you’re looking for support.

Boosting Progesterone Naturally

So maybe you've been tracking your cycle and you notice you have a short luteal phase, which is generally less than 10 days between ovulation and bleeding time, or you just had your progesterone tested and it came back low. It's possible your doctor recommended progesterone cream and maybe you're looking for other ways to increase your own production of progesterone. Here are my top progesterone production boosting tips!

Natural ways to increase progesterone production

1. Get better sleep

Getting good rest is not entirely specific for increasing progesterone levels but it is important for allowing your body to heal, period. So, sleep is an important place to start if you're experiencing any kind of imbalance and this should be the number one focus before implementing other kinds of supplementation. Sleep issues can stem from an overexcited nervous system, liver stagnation, adrenal imbalance, poor sleep hygiene, or many other reasons and if the reason you're not resting well is unclear to you, I encourage you to work with someone to figure out how to help you figure out what is preventing you from sleeping well. 
 

2. Eat more cholesterol & fat

Progesterone is one of several hormones produced from cholesterol. While not everyone absorbs large amounts of cholesterol from their diet, consuming enough cholesterol and fat is important for hormone balance and the integrity of your cells walls and therefore tissues. Fat is also important for blood sugar balance and insulin resistance, which plays directly into the health of your hormones. Make sure you're looking towards high quality sources of fat and cholesterol, such as egg yolks, avocado, coconut, pasture-raised, 100% grass-fed animal meats and fats, sardines, wild salmon, anchovies, and oils from things like olive, coconut, avocado. 
 

3. Castor oil

The liver processes all of our hormones and helps clear excess hormones from the system. Excess estrogen can contribute to progesterone deficiency and topical castor oil packs are a great way to help support the liver in clearing the extra estrogen. Symptoms of estrogen excess include breast tenderness and fluid retention, often seen just before your period starts. Estrogen disruptors are very present in our environment in plastics and many skincare products and can also be caused by excess abdominal fat and blood sugar imbalance. Daily rituals like castor oil packs on the abdomen are an amazing way to support daily detoxification and promote regular self-care. 
   

4. Seed cycle

If you don’t already have my FREE Seed Cycling Guide, make sure you do that first because it’s where I go in depth into the whys and hows of seed cycling. In its most basic form, seed cycling is when you rotate flax/chia/hemp seeds in the first half of your cycle and sesame/pumpkin/sunflower seeds in the second half of your cycle to support the balance of estrogen and progesterone, which is the foundation for a healthy menstrual cycle and fertility. I often add fish oils and evening primrose oil and sometimes homeopathic remedies throughout the cycle to additionally support hormone rhythms throughout the month. It's amazing how something so simple and cost effective can be so effective in correcting hormone imbalance. 
 

5. Vitamin B6

This B vitamin is essential in the production of the corpus luteum, which is formed in the ovary after ovulation. The corpus luteum then releases progesterone, which is why progesterone is higher in the second half of your cycle, after ovulation. Foods high in B6 include liver, all animal meat, salmon, eggs, avocado and pistachios. I rarely supplement B6 alone and generally recommend a B-complex to make sure those vitamins are being consumed in balance. 

6. Vitex 

Vitex agnus castus, or Chaste Tree, is a wonderful hormone balancing herb for women. It works by increasing Lutenizing Hormone (LH), which is required to stimulate ovulation, which then helps increase the release of production and release of progesterone from the ovaries. Vitex also reduces prolactin levels, which is a hormone that can effect progesterone levels. Just to create realistic expectations, Vitex can take some time to be effective so long-term use is generally required. 

Think you might need more support?

If you think you could benefit from some guidance in working to balance your hormones, improving your fertility, dealing with infertility, PCOS or whatever symptoms you're experiencing that you think may be hormone related, I'd love to work with you. I see patients in Bend, OR and work with people long-distance as well. Click here to learn how to become a patient. 

Photo by Andressa Voltolini