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. 

The Importance of Well-Woman Exams

Probably not your fav appointment you have on your schedule but usually a good idea to keep up with them anyway. I don’t perform annual exams in my office so I refer to trusted practitioners in my community. I just went in for an annual exam myself and realized it’s really important for YOU to be empowered with knowing whether or not you’re receiving an adequate and thorough exam.

Like most things, quality here can vary a lot and a complete exam is important for early detection of things like breast cancer, thyroid issues and also helping you figure out if there are symptoms you’re having that you might consider normal but are indicative of an underlying condition. So here are what I consider the essential elements of a complete well-woman exam.

The conversation. Your practitioner should ask about any concerns you’re having, your general health, menstrual history, any pain you’re having (cramping, with intercourse, mid-cycle), thyroid health (cold hands/feet, constipation, hair loss), weight gain/loss, unwanted hair growth, sleep & mood at the very least.

The breast exam. The breast exam should last at least 3 minutes if not 5. A thorough breast exam involved slow circular motions covering the armpit to sternum and collarbone to under the breast. The provider should be looking at your breast and inching their fingers along the tissue to make sure no areas are missed. Small growths can go easily undetected if an area is missed. Ask them to show you how to do this at home as well if you aren’t checking yourself regularly.

The pelvic exam. The exam should start with asking your experience with pelvic exams in the past. Your lymph nodes in your groin should be assessed, then pelvic muscle tone, they should check for any prolapse. Then the pap smear (when appropriate) is done and finally they should palpate (feel) your ovaries and uterus for size and texture.

Pay attention at your next exam and make sure you’re getting this kind of care and that you also really like who you’re seeing. If you don’t, move on and find someone that spends the time and listens to you.

Have any specific questions about annual exams? Ask away!