Understanding Your Lab Tests For Pcos
If you have polycystic ovary syndrome , you may be experiencing any number of symptoms, like irregular menstrual cycles or signs of high androgen levels, including acne and abnormal hair growth .
If you stop menstruating or your healthcare provider suspects you have PCOS, a number of tests may be ordered to determine whether PCOS is the cause or some other condition is involved, such as an underactive thyroid gland .
Unlike other medical conditions, the diagnosis of PCOS is based largely on a process of elimination. There is no single blood test that can diagnose the disease. Rather, the healthcare provider will accumulate evidence from blood worksalong with imaging studies and a pelvic examto help support the diagnosis of PCOS.
Can A Blood Test Help To Diagnose Menopause
Yes, in certain circumstances but their reliability depends on your age and several other factors. More on this will be explained below, but first, its important to understand that hormonal blood tests work by measuring the hormone levels in your blood. When you are in menopause or post-menopause, the hormonal changes expected to be found in your blood are low levels of the sex hormone estradiol and raised levels of the gonadotrophin hormones FSH and LH , which control the functioning of the ovaries. When the ovaries start to fail, FSH and LH levels increase in an attempt to keep the ovaries going. If a blood test confirms raised menopause-range FSH levels, it can be a good indication that you are undergoing menopause. However, it is not clear cut! A test indicating raised, menopausal-range FSH levels should be repeated in 6 weeks to confirm that you are in menopause. In contrast, a normal, non-menopausal range FSH level does not rule out menopause.
Can I Take The Test At Home
There are several at-home collection test kits for checking testosterone levels that are available without a prescription. These test kits may be sold at your local pharmacy and are also available online.
Self-collection kits contain all of the materials needed to obtain a blood or saliva sample and mail it to a laboratory for testing. Results from at-home testosterone tests are usually available within a few days.
If you have concerns about your testosterone levels, it is important to talk with a health care provider. At-home testosterone testing doesnt replace talking with a doctor, especially if you have a change in your health.
If the results of an at-home test are abnormal or if you are having symptoms, your doctor might want to order another testosterone test. They may also suggest a physical exam or other types of tests to assess your overall health.
For more information about taking at-home tests, see our At-Home Tests page.
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What Are The Different Types Of Hormone Tests
Practitioners can test hormone levels using blood, urine, or saliva samples. Each type of test has advantages and disadvantages with regard to an individuals health, the hormones to be tested, the hormone treatments already underway, and other variables. In some cases, your individual preference may also be a factor in choosing the best type of test.
How Do Doctors Make The Diagnosis Of Pcos
Currently there is some disagreement among doctors about the criteria required in order to make the diagnosis of polycystic ovarian syndrome.
At least 2 definitions are commonly used:
- In 1990 a consensus workshop sponsored by the NIH said the diagnosis of PCOS can be made if all 3 of the following are present:
- Clinical or biochemical signs of androgen excess
- Other entities have been excluded that would cause a polycystic ovary-like syndrome
Other entities that need to be excluded would include:
- Congenital adrenal hyperplasia, a defect of the enzyme 21-hydroxylase. The hormone 17 hydroxyprogesterone accumulates in the bloodstream in this condition.
- Cushings syndrome
- Androgen secreting tumor
- Women with non-androgenic conditions such as hyperprolactinemia, that can result in irregular periods and polycystic ovaries.
What matters most is not what we name it, but whether we recognize the problem and treat it effectively.
What do we mean by clinical or biochemical signs of androgen excess?
Some clinical signs of androgen excess include:
Some biochemical signs of androgen excess include:
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When To Test Progesterone
Progesterone levels are highest 5-7 days following ovulation, which is within our luteal phase . This is why testing is recommended days 19-22 of a 28 day cycle.
Even though were commonly told that women ovulate like clockwork on day 14 of their cycle, unfortunately, this isnt always the case. Its a great idea to track your basal body temperature and evaluate your cervical mucus to get an idea of when and if you are ovulating. Or you can use over-the-counter LH strips which can help you dial in the day you ovulate.
Ive got a whole article devoted to this practice, but the general idea is pretty simple, but can take some time. When you ovulate, your body temperature rises and your vaginal discharge becomes the consistency of stretchy egg whites. If you keep an eye on these changes to your body, theres a pretty good chance you can approximate when youre ovulating.
For a lot of women, this will mean that testing for progesterone should happen on roughly day 19-22 of their cycle. Again, this recommendation could change if youre not ovulating day 14 of your cycle which is actually pretty common, or if your typical cycle is shorter or longer than 28 days. Track your cycle for a few months before and talk to your doctor so that they can tell you the best day to test progesterone.
If you feel confused, talk to the provider ordering your test.
Are Test Results Accurate
Measuring testosterone in the blood is a routine procedure, and results are generally considered accurate when performed in an accredited laboratory that follows established testing methods.
One factor that may impact your testosterone level is the time of day when your blood is drawn. Testosterone levels are best evaluated from blood drawn in the morning when they are usually at their highest point. In addition, some drugs or medications may impact testosterone test levels.
If you have concerns about the accuracy of your test result, you can talk with your doctor. They can tell you about the laboratory that conducted the test, the reference range used, and the reliability of your test results.
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How To Measure Tsh Levels
The TSH test involves a healthcare professional drawing blood from a vein in the inner arm. They then send the blood sample for laboratory testing.
Usually, people do not need to prepare for a TSH test. However, if the doctor is checking the blood for more than one issue, a person may need to fast or prepare in another way. The doctor will provide this information beforehand.
A TSH test is often the best way to monitor thyroid function. However, if a person has abnormally high or low TSH levels, the doctor may need to perform at least one other diagnostic test to identify the underlying cause. These tests look at levels of specific thyroid hormones and antibodies.
Hormonal Changes In The Menopause
Menopause causes a change in hormone levels, such as decreased levels of the hormones oestrogen and progesterone. On average, menopause usually occurs between 45 and 55 years of age.
Menopause is a natural change which all women will go through, but it can have a big impact on a womanâs sense of wellbeing. Symptoms of menopause include:
- Mood changes such as depression and anxiety
- Changes to your menstrual cycle
- Reduced sex drive
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Hormonal Imbalance In Pcos
A number of hormones influence the signs and symptoms of PCOS even small changes in hormonal levels can cause notable symptoms. In PCOS, the levels of pituitary hormone called luteinizing hormone and the levels of insulin in the blood are usually too high.1 This causes the ovaries to make an excessive amount of testosterone. The majority of excess testosterone is produced by the ovaries, but excess androgen can also come from the adrenal glands, which sit on top of the kidneys. High testosterone levels are responsible for the many physical symptoms of PCOS such as facial and body hair growth, acne, and hair loss. Some evidence suggests that it also interferes with the normal function of the ovaries.2
What Day Should Estrogen Levels Be Checked
When evaluating female estrogen levels, day 3 is when estradiol, along with follicle stimulating hormone and luteinizing hormone blood tests will be performed.
Testing at the beginning of the cycle, along with FSH can help us understand brain-ovarian communication. Measuring FSH and LH is important to assess how the brain is talking to the ovaries.
When Should FSH Levels Be Checked?
For fertility or evaluating ovarian reserve, FSH is tested on day 3 of your cycle. If you cannot have lab testing done, most providers are fine testing between days 2-4. Remember, day 1 is the first day of your period.
Testing on or around day three of your cycle can be helpful in evaluating PCOS diagnosis as well. Note, this test alone will not diagnose PCOS. FSH and LH can help us understand how the brain is talking to the ovaries and the hormones can help us know how the ovaries respond to that message.
Why Test Estradiol?
During your reproductive years, estradiol or E2 is the predominant form of estrogen. As we transition into menopause, estrone or E1 becomes the most common circulating estrogen. This is important to understand because depending on the phase of life you are in, your estrogen levels and the type of estrogen will vary.
If you are in a phase of life where you should be having periods, you need to check estradiol.
Testing Estrogen Days 19-22 of Cycle
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What Tests Are Included In This Package
Luteinising hormone
Luteinising hormone plays a key role in reproduction. Mid-cycle, your LH levels increase which triggers your ovaries to release an egg ovulation. If your LH levels are too high or low you might have irregular periods and have trouble getting pregnant. High LH levels can be a sign that youre menopausal or have PCOS.
Follicle-stimulating hormone helps your ovaries to function normally and plays a key role in egg production and ovulation. Your FSH levels naturally increase as you age high levels can be a sign that youre menopausal. If your FSH levels are too high or low you might have trouble getting pregnant.
Testosterone
Testosterone is a sex hormone thats important for your sex drive, bone and muscle health, mood, and cognitive function. Your levels gradually drop as you age this process speeds up around perimenopause and menopause. If your levels are out of range you might feel tired, have a low sex drive, and have low mood.
SHBG
Sex hormone-binding globulin binds with certain hormones and transports them in your blood. When these hormones are bound to SHBG your body cant use them. This helps regulate how much is available for your body to use. If your SHBG levels are too high or low it can cause affect your testosterone and oestradiol levels.
Thyroid function
A basic thyroid profile measures Thyroxine , the main hormone produced by your thyroid, and thyroid-stimulating hormone a hormone that regulates your thyroid.
Oestrogen
Hormone Levels And Pcos
Remember that PCOS cannot be diagnosed by symptoms alone. PCOS is a very complicated endocrine disorder.
Remember that PCOS cannot be diagnosed by symptoms alone. PCOS is a very complicated endocrine disorder. Blood tests to measure hormone levels, an ultrasound to look at your reproductive organs and thorough personal and family histories should be completed before a PCOS diagnosis is confirmed. Depending on your symptoms, your physician will determine exactly which tests are necessary. Assessing hormone levels serves two major purposes. First of all, it helps to rule out any other problems that might be causing the symptoms. Secondly, together with an ultrasound and personal and family histories, it helps your doctor confirm that you do have PCOS. Most often, the following hormone levels are measured when considering a PCOS diagnosis:
- Lutenizing hormone
Other hormones that may be checked include:
In addition, glucose, cholesterol levels might also be assessed.
Lutenizing Hormone and Follicle Stimulating Hormone
Testosterone
All women have testosterone in their bodies. There are two methods to measure testosterone levels:
- Total Testosterone
- Free Testosterone
DHEA-S
DHEA-S or dehydroepiandrosterone is another male hormone that is found in all women. DHEA-S is an androgen that is secreted by the adrenal gland. It is normal for women to have DHEA-S levels anywhere between 35-430 ug/dl. Most women with PCOS tend to have DHEA-S levels greater than 200 ug/dl.
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What Is The Connection Between Impaired Glucose Tolerance And Pcos
Health care providers have known for some time that many of the symptoms of PCOS are caused by too much of the hormone testosterone. With PCOS, the ovaries make too much of this hormone which can result in extra facial and body hair and menstrual problems. Many young women with PCOS also have high levels of insulin that can stimulate the ovaries to make testosterone. The high levels of insulin also increase the chance of getting diabetes. Your HCP will look at your OGTT results along with other test results to figure out the best treatment for you including exercise, weight loss , and sometimes, medication.
When Thyroid Levels May Be Tested
You may need a thyroid hormone test if you have symptoms of either an underactive thyroid or an overactive thyroid .
Hypothyroidism symptoms include:
| Pituitary disease |
If results start out with low TSH and high thyroid hormones and then reverse with further testing, it indicates thyroiditis, which is inflammation of the thyroid gland.
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What Is An Oral Glucose Tolerance Test
An OGTT is a way to measure your bodys ability to use glucose. Your pancreas makes a hormone called insulin, which helps your body use the glucose in your blood. If your pancreas doesnt make enough insulin or if your body is unable to use the insulin it makes, you may have a high blood glucose level. The OGTT involves fasting overnight and then having your blood checked early in the morning. You will then drink a special glucose drink and have your blood tested again after 2 hours. Sometimes blood sugar levels are also checked at other times such as 1 hour, 3 hours, or 4 hours after the glucose drink.
What Your Doctor Will Ask
Your doctor will want to know about all the signs and symptoms youâve noticed. This is an important step to help figure out whether you have PCOS, and to rule out other conditions that cause similar symptoms.
Youâll need to answer questions about your familyâs medical history, including whether your mother or sister has PCOS or problems getting pregnant. This information is helpful — PCOS tends to run in families.
Be ready to discuss any period problems youâve had, weight changes, and other concerns.
Your doctor may diagnose PCOS if you have at least two of these symptoms:
- Higher levels of androgen shown in blood tests or through symptoms like acne, male-pattern balding, or extra hair growth on your face, chin, or body
- Cysts in your ovaries as shown in an ultrasound exam
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Health Conditions And Female Hormones
Polycystic Ovary Syndrome is a condition that stops eggs from developing normally in the ovaries. Symptoms of PCOS include:
- Excessive hair growth
- Irregular or missed periods
- High levels of the male hormone testosterone
Thyroid problems, such as an overactive or underactive thyroid, can also affect the development of eggs in your ovaries and hence affect your hormone levels.
Testing your hormone levels can help you to understand whether a health problem, such as PCOS or a thyroid problem, is leading to hormonal changes in your body.
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Is There Anything The Patient Needs To Do To Prepare For Having Tests Taken
The doctor will advise the patient on how to prepare, because it depends on the particular test. Most preparation is obvious once it is understood that hormones keep the body working and levels change to meet various demands such as fasting, eating, thirst, smoking, exercise, posture, time of day, stage of the menstrual cycle and medicines.
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What Do I Need To Do Before The Ogtt
Your health care provider will most likely give you either a glucose drink to take home or a prescription to bring to your pharmacy or the lab. Some tests are done in a health care providers office, but most often the test is done in a lab at a hospital or clinic. The test takes several hours , so youll need to plan on being at the lab or your HCPs office for most of the morning. If you need to fill a prescription, be sure you call your pharmacy ahead of time to see if they have the glucose drink in stock, because some pharmacies may not carry this item, or they may need to order it.