Which Tests should I do to help Diagnose PCOS?

Going to the Doctor for most people can be stressful, more so when you are not in the medical field where you can understand what the doctors tests mean and why they are doing them. This can be especially stressful for a woman who is trying to conceive but explanations are not given to her along the way,

I remember having to go for numerous blood tests and the doctors never really telling me why I need to have those tests or what it was they were looking for. Now, most women with PCOS have already been diagnosed through the use of a Pelvic Ultrasound to detect the cysts on their ovaries. The other blood tests that seem to be routinely done are for a hormonal profile, blood glucose and thyroid tests. Most doctors, having made diagnosis through ultrasound and the hormonal profile will stick to the fact that they have made a diagnosis of PCOS and will subsequently prescribe the pill/Metformin.

In my case, I had tried for a couple of years to try and conceive but I really wasn't in any hurry to be honest. I started to think, if it happens it happens, if not then that's OK too. However, after a while I started to notice my normal symptoms of PCOS were going haywire and that is when I made a conscious decision to go to a doctor that seemed to be the best at what he does for fertility in women.

Sitting in a chair across from my Doctor for the first time, I had to admit I was nervous and worried that he would dismiss my concerns again like every other doctor I had seen before him. Boy, was I wrong! So calm and collected he took the time to explain to me why he needed to run certain tests that had been overlooked by previous doctors in order to understand and pinpoint the UNDERLYING Hormonal cause of my PCOS. We needed to know which TYPE of PCOS I had, as I have explained in a previous post, in order to move forward.

I have spoken to a few ladies recently that have contacted me to know more about what tests have been done for them and why, so I wanted to take this opportunity to explain.

First we need to exclude any UNDERLYING hormonal issues that may be contributing to PCOS:

1. Thyroid Stimulating Hormone: This is done to rule out any thyroid dysfunction, or in some cases to look for Hashimoto's Thyroiditis, which leads to one type of PCOS.

2. Cortisol Levels: This test is done in order to rule out Cushing Syndrome. Cushing Syndrome is caused by over exposure to high Cortisol levels for a long period of time and can lead to PCOS due to other hormones falling out of balance.

3. Prolactin Levels: In order to rule out Hyperprolactinaemia. The exact mechanism of how Prolactin causes PCOS is not known but it has been linked to elevated Estrogen levels.

4. 17-Hydroxyprogesterone: to rule out the most common form of congenital adrenal hyperplasia. Again, this is related to the adrenal glands as I had explained in an earlier post about stress.

5. IGF-1: To rule out excess growth hormone.

6. DHEAS: To rule out an adrenal tumour.

Secondly, once we have ruled out other issues, I still think the following tests need to be done in order to accurately diagnose PCOS:

1. FSH levels: Generally this hormone tends to be lower than usual

2. LH levels: This hormone tends to be higher in women with PCOS. Generally two to three times higher. So doctors tend to look at that ratio to make a diagnosis.

3. Testosterone: May be elevated and higher than normal numbers

4. Estrogen: May be higher or within range.

5. HCG: To rule out Pregnancy.

6. Sex hormone binding globulin (SHBG) – may be reduced in PCOS. This hormone is important in binding to male hormones in the body so as to remove them. Women with PCOS tend to have more male hormones floating around in the blood. If SHBG is low, this causes an increase in androgens in the body.

7. Anti-Müllerian hormone (AMH) – an increased level is often seen with PCOS.

8. DHEAS – may be elevated

9. Androstenedione – may be elevated

Other tests to get done are as follows and seem to be the first ones that Doctors in Kenya do and then treat that as a diagnosis without doing any further tests to find out any other underlying causes OR if there are any other conditions that they can associate the PCOS to, in order to treat the condition:

1. Lipid panel – to help determine risk of developing cardiovascular disease; risk is associated with a low HDL, high LDL, high total cholesterol and/or elevated triglycerides

2. Glucose or HbA1c – can be used to screen for, diagnose and monitor diabetes

3. A pelvic ultrasound 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.In PCOS, the ovaries may be 1.5 to 3 times larger than normal and characteristically have more than 20 follicles per ovary. If present, the cysts are often lined up on the surface the ovaries, forming the appearance of a "pearl necklace."

4. Insulin Resistance: Last but not least, it is extremely important to get this test done to see whether there is Insulin Resistance or not that is causing your weight gain.

I know this is a lot to take in and can seem like a lot of science-y names and confusion but all we need to know is which hormones need to be in BALANCE. Once your doctor knows which one is high or low then they can move forward with their diagnosis.

For example, if the tests show that there is PCOS and Hypothyroid, then we can clearly assess the type of PCOS and make lifestyle adjustments accordingly.

I hope this helps to just keep you informed on the various tests that doctors send for when you have PCOS. If you need more info, please don't hesitate to contact me. :)