How To Test For PCOS (And What To Expect)

The question of “how to test for PCOS” is a bit more complicated than first meets the eye.

But let’s rewind for a second. What is PCOS, exactly? PCOS stands for polycystic ovary syndrome, and it’s a hormonal disorder that’s relatively common in women of reproductive age (the CDC estimates around 1 in 10 women have it). Although the cause is still unknown – more research needs to be dedicated to this area of women’s health in particular – most experts believe it is most likely related to androgen excess and insulin resistance, and the way these two cofactors interact, potentially exacerbating each other.

But unfortunately, for many women, meeting with a healthcare professional and receiving a certain ‘yes’ or ‘no’ on whether you have PCOS is anything other than clear-cut. There are a myriad of reasons for this, but an important thing to know in advance of seeking out answers is that because there is no one checkbox you need to fill in order to receive a PCOS diagnosis, it can be difficult to get a conclusive answer. Instead, a positive PCOS diagnosis is often a result of assessing multiple symptoms and criteria, and tests such as blood tests are just a piece of this overall picture that doctors and other healthcare professionals will try to capture.

That being said – here’s some of what you can expect when you go through the process of being tested for PCOS.

A Closer Look At How To Test For PCOS

1. Medical exam

The first stop on your PCOS journey is to see your doctor.

Your primary health care provider will assess you to see how many, if any, symptoms of PCOS you display. They may also ask you questions about your symptoms such as when they began, whether they’ve gotten worse or stayed consistent over time, as well as inquiries about your medical history.

There are many symptoms of PCOS (which is why we have an entire article dedicated to common side effects of PCOS, as well as a special diagnostic visit), but here are some of the most notable symptoms most women experience:

  • Weight gain
  • This is a common finding thanks to the insulin insensitivity that accompanies the majority of women PCOS.
  • Women with PCOS seem to have reduced insulin sensitivity, by an average of  35-40%, compared to women without PCOS, according to one study. This means for women with PCOS that insulin levels need to increasingly rise in order to get sugar into their muscle cells, but as the body becomes more and more desensitized to insulin, the body needs to create more of it to get cells to open. This eventually leads to a build up of sugar (otherwise known as glucose) in the blood, which in turn can make it harder to lose weight and put women with PCOS at increased risk of type 2 diabetes. Check out our article on everything you need to know about sugar and PCOS for more information on this topic, written by our Registered Dietitian, Felice. It covers everything from sugar cravings, to how insulin resistance develops, to practical advice on what to do to reduce your intake of high-sugar meals and snacks in a sustainable way.
  • Acne
  • Thought to be triggered by excess levels of androgens such as testosterone, acne is a common side effect with physical and emotional implications, as many women report feeling distress, shame, and even depression as a result of stubborn acne.
  • Excess hair growth
  • Also known as “hirsutism,” this symptom is again thought to be the culprit of too-high androgen levels. This excess hair growth is often found on the face, chest, and back, and is a common manifestation of PCOS.
  • If this hair growth does bother you, there are medications which may help. Also electrolysis and laser treatment are accessible solutions which can be permanent (or at least long-lasting).
  • Irregular or no period
  • The menstrual cycle begins from the first day of your period to the first day of your next period, with the average menstrual cycle hovering around the 28 day mark. Menstrual flow occurring every 21 to every 40 days is considered normal, with a flow that lasts two to seven days. For the first few years after menstruation, longer cycles are common (as is irregularity), but tend to shorten and become more regular as one ages.
  • If you get your period more often than every 21 days, or you go longer than 40 days between periods, then that is considered irregular.

An important note here on understanding if your period is regular or not, since this is often a question doctors will ask when reaching a PCOS diagnosis: if you don’t know when you get your period – don’t panic! Many women often don’t take a closer look at their periods until they are trying to conceive, or they come off of hormonal birth control. It’s worth pointing out here that if you are on an oral contraceptive, or another type of hormonal birth control, you won’t have a period each month. This can be somewhat surprising if you didn’t already know this, especially since many pills do offer a 7 day ‘break’ in which you bleed for several days. In fact, this is a breakthrough bleed, which is not a period.

On hormonal birth control (this excludes contraceptives like vaginal sponges, female condoms, and the copper IUD), you will not get a period since you do not ovulate. To know if you have regular periods or not, you would need to come off of hormonal birth control and track spotting, bleeding, and so on. To help you track, there are apps (such as Period Tracker, Clue, and Flo), many of which are free. The flow of your period also matters, so keeping track of how much you’re bleeding (women with PCOS tend to get heavy periods, when they arrive, as a result of low levels of progesterone) can be done by using a menstrual cup, or counting how many tampons and pads you use. An average amount of blood to lose on your period is between 30ml to 40ml, but it can be up to 60ml.

Now that we’ve covered symptoms and tracking your period, let’s examine some common questions a physician may ask to discover if PCOS is a likely root cause of some of your symptoms:

  • When was your last period?
  • If you have noticed weight gain, when did it begin?
  • Have you found anything that improves or worsens your symptoms?
  • Are you trying to become pregnant?
  • Have any of your family members been diagnosed with PCOS, or displayed symptoms of PCOS?

Because there are multiple symptoms of PCOS, it’s a good idea to keep a journal (or even take notes on your phone) to keep track of any body changes. This way, you can try to be as objective as possible and gauge the state of your symptoms over a defined period of time. You can then share this information with a chosen healthcare professional in order to gain a deeper understanding of what is going on in your body.

It’s also important to remember that no two cases of PCOS are exactly the same: your biology is unique, and so the way that PCOS manifests itself may be different for you than it will be for a friend, a family member, or anyone online. Give your doctor as much detail as possible regarding potential symptoms, so that they can build a full picture as to what is going on internally.

2. Blood tests

Blood tests will help decipher whether you have PCOS, as they can lend more insight into the state of a hormonal imbalance in your body.

Doctors will be looking for the following:

  • Follicle stimulating hormone (FSH)
  • FSH is made by your pituitary gland, and if you have PCOS, your level may be lower than normal
  • The FSH test is different from a regular CBC test that may be conducted as part of an annual physical exam; the FSH test is often used to help diagnose symptoms that indicate a hormonal imbalance or thyroid issue
  • Testosterone
  • Since androgen excess (worsened by insulin resistance) can be the culprit or unwanted symptoms such as excess body hair, acne, and hair loss, this test result may be higher than normal
  • If that is the case, there are steps you can take to try to balance your androgen levels, which may include reducing your artificial sugar intake, incorporating ‘androgen antagonists’ (such as green tea) into your diet, and pursuing other holistic medicines. There are also anti-androgen medications available, if you are open to prescription solutions.
  • Luteinizing hormone (LH)
  • This may be higher than normal
  • In women without PCOS, the ratio of LH to FSH is usually 1:2, but for women with PCOS, it may be 2:1 or even 3:1.
  • Estrogen
  • Since PCOS is characterized by excess androgen levels, you may expect this to be lower in women with PCOS, but surprisingly it is the opposite: women with PCOS often have high estrogen levels and insufficient progesterone, which prevents ovulation (and thus missed or irregular periods).

3. Glucose and cholesterol tests

This may come after you’re diagnosed with PCOS, but it is a key part of the PCOS journey: understanding how polycystic ovary syndrome is affecting you internally, as well as externally.

Here are a couple of popular tests that may be conducted to understand the effects of PCOS on your long-term health.

  • Lipid profile

Lipid profiles check your cholesterol and triglycerides. Cholesterol is a form of fat we need, but like with most things, there are “good” and “bad” forms of this fat. Low-density lipoprotein (LDL) is the ‘bad’ type which can stick to blood vessel walls, and over time, it can clog arteries, leading to blood clots and heart attacks.

Triglycerides are another type of fat that doctors take into account when cholesterol testing. High levels of triglycerides can increase your chances of heart attack or stroke, especially if you have low levels of “good” cholesterol (otherwise known as high-density lipoprotein, HDL). High triglyceride levels can suggest an increased risk of diabetes, which is important in women with PCOS, since due to increased insulin-insensitivity, they are vulnerable to being diagnosed with type 2 diabetes later down the line.

  • Glucose test

Glucose tests are useful for helping figure out if you have diabetes. As mentioned before, women with PCOS are at increased risk for type 2 diabetes: one study, conducted in 2017 in Denmark, found that women with PCOS were 4 times more likely to be diagnosed with PCOS than women without PCOS, and they would also be diagnosed with the disease 4 years earlier on average.

  • Insulin test

Here, your doctor will want to see how your body reacts to insulin. Since insulin insensitivity is such a driving force behind PCOS, it’s important for doctors to understand as much as possible about your blood sugar levels. Usually insulin tests take the form of:

  • Fasting plasma glucose test

This measures your blood sugar after you haven’t eaten for a minimum of 8 hours.

  • Oral glucose tolerance test

First, you take the fasting glucose test, and then you’ll drink a sugary solution. 2 hours later, you’ll take another blood test.

  • Hemoglobin A1c test

This blood test shows your average blood sugar levels for the past 2 to 3 months. Doctors use it to diagnose prediabetes or diabetes.  

  • Ultrasound

As part of an evaluation for PCOS, your doctor may consider the Rotterdam criteria.

This requires hitting two out of the following three symptoms:

  • Irregular periods (also called oligomenorrea) or no periods (amenorrhea)
  • Higher levels of androgens present in the blood (hyperandrogenism) or physical characteristics of elevated androgen levels such as acne or excess hair
  • Polycystic ovaries visible on an ultrasound

To gauge if you have polycystic ovaries, your doctor may conduct a pelvic sonogram ultrasound, which involves placing a transducer on your abdomen and/or in your vagina. Beforehand, you may be asked to drink up to 42 ounces of water to fill your bladder, which will make it easier to see your ovaries. The transducer then emits sound waves that are translated to images on a computer screen, and the doctor can see if you have any cysts on your ovaries. Sometimes, there are a certain number of small follicles (measuring between 2mm and 9mm in diameter) which are thought to be the ‘minimum’ needed for a PCOS diagnosis, but there is no hard and fast rule.

In fact, some women diagnosed with PCOS have an ultrasound and discover that they have no cysts on their ovaries.

How To Test For PCOS – The Ongoing Debate

As you can see, a polycystic ovary syndrome evaluation is less of a rigid checklist that health care providers measure patients against, and more of a complicated, dynamic chronic condition that involves symptoms that have the ability to change over time. This is further reflected in the fact that the debate around how to test for PCOS is still being discussed among experts themselves.

For that reason, if you’re not sure about your doctor’s diagnosis, we absolutely encourage you to get a second opinion. This is something we can help with at Allara as well. When it comes to your health, there’s no such thing as being too big of an advocate for yourself.

Allara Health provides personalized treatment for hormonal, metabolic & gynecological conditions that utilizes a holistic plan that merges nutrition, lifestyle, medication and supplementation, and ongoing, expert support to heal your body.