Polycystic Ovary Syndrome (PCOS) affects approximately 1 in 10 women of reproductive age, making it one of the most common hormonal disorders. Yet the average woman waits 2-3 years and sees multiple doctors before receiving a diagnosis.
Part of the problem? Many healthcare providers only run basic hormone tests that don't capture the full picture. Here's the comprehensive lab panel that can help identify PCOS and its metabolic components.
What Is PCOS?
PCOS is a hormonal disorder characterized by:
- Irregular periods or absent menstruation
- Excess androgens (male hormones) causing acne, facial hair, or hair thinning
- Polycystic ovaries on ultrasound (though not all women with PCOS have cysts)
PCOS is also strongly linked to insulin resistance, which can lead to weight gain, difficulty losing weight, and increased risk of type 2 diabetes.
The Rotterdam Criteria
To diagnose PCOS, most providers use the Rotterdam criteria, which requires 2 of 3:
- Irregular or absent ovulation
- Clinical or biochemical signs of elevated androgens
- Polycystic ovaries on ultrasound
Blood work is essential for confirming androgen excess and ruling out other conditions that mimic PCOS.
The Complete PCOS Lab Panel
Androgen Markers
| Test | What It Reveals |
|---|---|
| Total Testosterone | Overall androgen level; often elevated in PCOS |
| Free Testosterone | Biologically active testosterone; more sensitive than total |
| DHEA-S | Adrenal androgen; elevated in some PCOS types |
| Androstenedione | Precursor hormone; can be elevated in PCOS |
| SHBG | Sex Hormone Binding Globulin; typically LOW in PCOS (means more free testosterone) |
Reproductive Hormones
| Test | What It Reveals |
|---|---|
| LH | Luteinizing hormone; often elevated in PCOS |
| FSH | Follicle-stimulating hormone; typically normal or low in PCOS |
| LH:FSH Ratio | Ratio >2:1 is suggestive of PCOS (though not diagnostic alone) |
| Estradiol | May be elevated due to constant follicular activity |
| AMH | Often HIGH in PCOS (reflects multiple small follicles) |
When to test: Hormone levels fluctuate throughout your cycle. For the most accurate results, test on cycle days 2-4 (early follicular phase). If your periods are irregular, your provider may have you test anytime.
Metabolic Markers (Often Overlooked!)
Up to 70% of women with PCOS have some degree of insulin resistance. This metabolic component is often undertested but crucial for management.
| Test | What It Reveals |
|---|---|
| Fasting Insulin | The most important test for insulin resistance - can be elevated even with normal glucose |
| Fasting Glucose | Blood sugar levels; may be normal even with insulin resistance |
| HbA1c | Average blood sugar over 3 months |
| HOMA-IR | Calculated from fasting insulin and glucose; measures insulin resistance |
| Lipid Panel | Cholesterol and triglycerides; often abnormal in metabolic PCOS |
Why Fasting Insulin Is Critical
Here's what many doctors miss: fasting glucose can be completely normal while insulin is sky-high. Your body is pumping out excessive insulin to keep blood sugar in range - but that elevated insulin:
- Signals ovaries to produce more androgens
- Promotes fat storage, especially around the midsection
- Makes weight loss extremely difficult
- Increases hunger and cravings
- Eventually leads to prediabetes and diabetes
Testing fasting insulin identifies this problem years before glucose becomes abnormal.
Rule-Out Tests
These tests help ensure your symptoms aren't caused by other conditions:
- Thyroid panel (TSH, Free T4, Free T3): Thyroid disorders can cause irregular periods and weight changes
- Prolactin: Elevated prolactin can cause menstrual irregularity and androgen-like symptoms
- 17-OH Progesterone: Rules out congenital adrenal hyperplasia, which mimics PCOS
- Cortisol: Cushing's syndrome can cause similar symptoms
The Four Types of PCOS
Not all PCOS is the same. Lab work helps identify your "type," which guides treatment:
- Insulin-Resistant PCOS: High fasting insulin, elevated androgens, often weight gain
- Adrenal PCOS: DHEA-S is elevated but testosterone is normal; stress-related
- Inflammatory PCOS: Normal androgens but elevated inflammation markers (CRP, ESR)
- Post-Pill PCOS: Temporary androgen rebound after stopping birth control
What to Do If You Suspect PCOS
- Track your cycles: Document menstrual irregularity, which is key diagnostic info
- Request comprehensive labs: Don't settle for just testosterone - ask for the full panel including fasting insulin
- Consider an ultrasound: Transvaginal ultrasound can identify polycystic ovarian morphology
- Get a proper diagnosis: Don't accept "probable PCOS" - you deserve a definitive answer
Important: PCOS is a diagnosis of exclusion. Other conditions must be ruled out first. Comprehensive lab work is essential.
You Deserve Answers
If you've been dealing with irregular periods, acne, excess hair growth, or unexplained weight gain, you deserve more than a quick dismissal. The right lab panel can finally give you clarity - and a path forward.
PCOS is manageable, but it starts with understanding what's actually happening in your body.
Take control of your health. Explore our comprehensive hormone testing options including testosterone, DHEA-S, insulin, and all the markers you need for a complete PCOS workup.
Sources
- World Health Organization. Polycystic ovary syndrome. WHO Fact Sheets.
- Gibson-Helm M, et al. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017.
- National Institute of Child Health and Human Development. What causes PCOS? NIH.
- Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria. Hum Reprod. 2004.
- Diamanti-Kandarakis E, et al. Insulin resistance and the polycystic ovary syndrome revisited. Endocr Rev. 2012.
- Huang R, et al. The LH/FSH ratio and polycystic ovary syndrome. Front Endocrinol. 2017.