E. Sterling

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:       

       Other hormones that may be checked include:       

       In addition, glucose, cholesterol (HDL, LDL and triglicerides) levels might also be assessed.       

              

Lutenizing Hormone (LH) and Follicle Stimulating Hormone (FSH)


       LH and FSH are the hormones that       encourage ovulation. Both LH and FSH are secreted by the pituitary gland in the brain.       At the beginning of the cycle, LH and FSH levels usually range between about 5-20       mlU/ml. Most women have about equal amounts of LH and FSH during the early part       of their cycle. However, there is a LH surge in which the amount of LH increases to       about 25-40 mlU/ml 24 hours before ovulation occurs. Once the egg is released       by the ovary, the LH levels goes back down.
       
       While many women with PCOS still have LH and FSH still within the 5-20 mlU/ml       range,        their LH level is often two or three times       that of the FSH level. For example, it is typical for women with PCOS to have an       LH level of about 18 mlU/ml and a FSH level of       about 6 mlU/ml (notice that both levels fall within the normal range of 5-20       mlU/ml).  This situation is called an elevated LH to FSH ratio or a ratio of 3:1. This       change in       the LH to FSH ratio is enough to disrupt       ovulation. While this used to be considered       an important aspect in diagnosing PCOS, it       is now considered less useful in diagnosing PCOS, but is still helpful when looking       at the overall picture.
       
       


       All women have testosterone in their bodies. There are two methods to measure       testosterone levels:       

       Total testosterone       refers to the total amount of all       testosterone, including the free       testosterone, in your body.  The range for this is 6.0-86 ng/dl.        Free testosterone refers       to the amount of testosterone that is       unbound and actually active in your body.  This amount usually ranges from 0.7-3.6       pg/ml.  Women with PCOS often have an       increased level of both total testosterone       and free testosterone.  Furthermore, even a       slight increase in testosterone in a woman’s       body can suppress normal menstruation and       ovulation.
       
       


       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.
       
       


       Prolactin is a pituitary hormone that       stimulates and sustains milk production in       nursing mothers. Prolactin levels are usually       normal in women with PCOS, generally less       than 25 ng/ml. However, it is important to       check for high prolactin levels in order to       rule out other problems, such as a pituitary       tumor, that might be causing PCOS-related       symptoms.  Some women with PCOS do have       elevated prolactin levels, typically falling       within the 25-40 ng/ml range.
       
       


       ANDRO is a hormone that is produced by the ovaries and adrenal glands. Sometimes       high       levels of this hormone can affect estrogen       and testosterone levels. Normal ANDRO levels are between 0.7 ­ 3.1 ng/ml.
       
       


       Progesterone is produced by the corpus       luteum after ovulation occurs.  Progesterone       helps to prepare the uterine lining for pregnancy.  For women with PCOS,       especially those who are trying to become       pregnant using fertility medications,       Progesterone levels are checked about 7       days after it is thought that ovulation       occurred.  If the Progesterone level is high       (usually greater than 14 ng/ml) this means       that ovulation did indeed occur and the       egg       was released from the ovary.  If the       progesterone level is low the egg was       probably not released. This test is       especially       important because sometimes women with       PCOS can have some signs that ovulation is       occurring however, when the progesterone       test is done, it shows that ovulation did not       occur. If this happens, your body is       may be       producing a follicle and preparing you to ovulate, but for some reason the egg is       not       actually being released from the ovary.  This       information helps your physician possibly       adjust fertility medication for the       next cycle       to encourage the release of the egg.
       
       


       Estrogen is the female hormone that is       secreted mainly by the ovaries and in small       quantities by the adrenal glands.  The most       active estrogen in the body is called estradiol.  A sufficient amount of       estrogen is       needed to work with progesterone to       promote menstruation. Most women with       PCOS are surprised to find that their       estrogen levels fall within the normal range       (about 25-75 pg/ml).  This may be due to       the fact that the high levels of insulin and       testosterone found in women with PCOS are       sometimes converted to estrogen.
       
       


       TSH stands for Thyroid Stimulating Hormone       and is produced by the thyroid, a gland       found in the neck. Women with PCOS usually       have normal TSH levels (0.4-3.8 uIU/ml).  TSH is checked to rule out other       problems,       such as an underactive or overactive       thyroid, which often cause irregular or lack of periods and anovulation.
       
       


       Due to the recent research that PCOS is       probably caused by insulin resistance,       physicians are beginning to check glucose       levels as a factor when diagnosing PCOS.         Most women with polycystic ovary syndrome should have an Fasting Plasma Glucose       Test and a Glucose Tolerance Test at diagnosis       and periodically thereafter, depending on       risk factors.  A high glucose level can       indicate insulin resistance, a diabetes-related condition that       contributes       to PCOS.
       
       


       Researchers are also beginning to notice a       connection between PCOS and heart       disease; therefore, some physicians may want to look at your cholesterol levels       when diagnosing and treating PCOS. Women with       PCOS have a greater tendency to have high       cholesterol, a major risk factor for developing heart disease. Cholesterol       is a fat-like substance normally used by the       body for form cell membranes and certain       hormones.  A high cholesterol level is       considered greater than 200. Also, since the       levels of good (high-density lipoproteins or HDL) and bad (low-density lipoproteins       or LDL) are sometimes more indicative of a       woman’s risk for developing heart disease,       these levels might also be assessed.
       
       Too much bad cholesterol tends to increase       the risk for plaque to build up in the arteries       which can lead to a heart attack. Too much       good cholesterol is believed to remove the       cholesterol from building up in the       arteries.  Women with PCOS tend to have less good       cholesterol and more bad cholesterol.  In       addition, triglyceride levels, another       component of cholesterol, tend to be high in       women with PCOS which further       contributes       to the risk of heart disease.  Even if your       physician does not check your cholesterol       levels when diagnosing PCOS, it is a good idea to have these levels checked       periodically since women with PCOS have a       greater chance of developing high cholesterol which can lead to heart disease.
       
       


       It is important to remember that with all       women, hormone levels can very greatly.  It       is also important to mention that since the       “normal” ranges vary greatly for some       hormones (especially since each lab sets its       own “normal” values for these hormones),       some women with PCOS have hormone       levels that appear within the “normal”       range,       but still suffer from symptoms and still might       have PCOS. This is especially true with       Testosterone , DHEAS, and LH levels.  Unfortunately, many physicians are not       familiar enough with PCOS to understand       that even small changes in hormone levels       can cause PCOS-related symptoms.  If you       have a Testosterone level of >40 ng/ml,       DHEAS level of >200 ug/dl or a LH level that       is two or three times that of your FSH level       (LH and FSH levels should be roughly equal), seek the advice of a specialist since       there is still a good possibility you might have PCOS.       

Angela Best-Boss and Evelina Weidman Sterling, authors of 

Articles

Remember that PCOS cannot be diagnosed by symptoms alone.  PCOS is a very complicated endocrine disorder.

E. Sterling

Articles

Hormone Levels and PCOS