Polycystic Ovary Syndrome
PCOS is a common condition associated with small fluid-filled follicles in the ovaries and affects around 1 in 10 women. Each follicle contains an immature egg that does not develop enough to trigger ovulation causing low progesterone levels and abnormally high levels of androgens like testosterone. PCOS is thought to be a metabolic condition whereby insulin resistance is the primary driver of the sex hormone imbalance.
Symptoms of PCOS include irregular periods, fertility issues, hirsuitism, male pattern alopecia, abdominal bloating and acne. Symptoms may differ depending on the individual as such its a good idea to have a baseline screen done of all the hormones typically involved in PCOS to understand whether or not they are effected.
PCOS may increase the risk of diabetes, thyroid disorders and high cholesterol, our PCOS panel will help to identify any associated risks as well as measure the levels of several key hormones.
PCOS cannot be diagnosed by symptoms alone. PCOS is a very complicated endocrine disorder. Blood tests to measure hormone levels, a referral for an ultrasound to look at your ovaries and a thorough medical histories are advisable before a PCOS diagnosis is confirmed.
Our PCOS blood test panel measures over 45 data points including female hormones, androgen levels (testosterone) and helps check blood parameters commonly effected by PCOS such as cholesterol and insulin levels and tests to rule out other possible causes of your symptoms such as a full thyroid hormone profile and prolactin levels.
Cost: €299
The PCOS panel includes –
Hormonal health: oestradiol, follicle stimulating hormone, luteinising hormone, progesterone, prolactin, testosterone, sex hormone binding globulin, free androgen index.
Thyroid health: thyroid stimulating hormone, free thyroxine, free tri-iodothyronine, anti-thyroglobulin antibody, anti-thyroid peroxidase antibody.
Nutritional health: vitamin D
Heart health: total cholesterol, LDL cholesterol, HDL cholesterol, total cholesterol/HDL cholesteroal ratio, triglycerides.
Stress: Cortisol, DHEA-S
Infection & Inflammation: C-Reactive protein.
Iron Status: iron, ferritin, total iron binding capacity, transferrin, transferrin saturation.
Full blood count: haemoglobin, haematocrit, mean cell haemoglobin, MCHC, red blood cell count, basophil count, eosinophil count, lymphocyte count, monocyte count, neutrophil count, white blood cell count, platelet count.
Liver health: alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, gamma-glutamlytransferase, total bilirubin, albumin, ferritin.
Kidney health: chloride, phosphate, potassium, sodium, urea.
Diabetes health: glucose, HbA1c, insulin.
Anti-mullerian hormone can be added to the panel for an extra €50 if patient requests it.
Adding testing for 17 hydroxyprogesterone to outrule congenital adrenal hyperplasia will incur an additional charge
Frequently Asked Questions
What day of my menstrual cycle should I schedule my appointment?
If you are attending for Polycystic Ovary Syndrome (PCOS), please attend on day 2 or day 3 of your cycle, (day 1 is the day your start your period).
How do I prepare for my appointment?
Recommended to fast. Please do not consume food or drink for 8 hours prior to the appointment. |You should drink plenty of water to keep well hydrated, but no other types of drinks. Non fasting can impact the following; heart health, cardiovascular risk score, diabetes health, or iron status.
What is follicle stimulating hormone (FSH)?
FSH stimulates the production of oestradiol and promotes the development of ovarian follicles. FSH levels peak just before ovulation, with levels lower during the luteal phase of the menstrual cycle to prevent the development of new follicles. Due to the fluctuation of FSH levels during the menstrual cycle, its is recommend levels are measured within the first 4 days of the cycle. A common reason for increased levels of FSH is the menopause.
What is luteinising hormone (LH)?
LH plays an important role in reproductive health. LH levels peak in the middle of the menstrual cycle triggering ovulation. Measurement alongside other hormones at the beginning of the cycle can help to identify a hormone imbalance that could be affecting ovulation.
Why is the level of FSH and LH important to measure?
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.
It is common for women that clearly fit the PCOS syndrome in other ways to have normal serum FSH and LH levels and a normal FSH to LH ratio. For this reason, testing of FSH and LH hormone levels is not always helpful when trying to diagnose PCOS.
In summary:
- A ratio ≥2.0 is suggestive of PCOS but is not highly sensitive or specific.
- Gonadotropin levels are affected by oral contraceptives
What is oestradiol?
Oestradiol is the main form of oestrogen in the body. Oestradiol is essential for ovulation, conception and pregnancy, measuring your oestradiol levels can provide insight into ovarian function.
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.
What is progestogen?
Progesterone plays an important role in preparing your body for pregnancy after ovulation. Levels increase when you ovulate, measuring your progesterone levels in the luteal phase of your cycle after the time for ovulation can therefore indicate if you have ovulated and releasing healthy eggs.
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.
What is prolactin?
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 496 miu/l. However, it is important to check for high prolactin levels in order to rule out other problems, such as a pituitary tumor, that could cause amenorrhea (lack of periods). Some women with PCOS do have mildly elevated prolactin levels, typically falling within the 300-400 mui/l range.
What is testosterone?
Measuring your testosterone levels may help to determine the cause of symptoms such as oily skin, excess body hair and irregular periods. High levels are associated with conditions like PCOS.
What is testosterone and free testosterone?
All women have testosterone in their bodies. There are two methods to measure testosterone levels:
- Total Testosterone
- Free Testosterone
Total testosterone refers to the total amount of all testosterone, including the free testosterone, in your body. The range for this in women is 0.29 – 1.67 nmol/l. Free androgen refers to the amount of androgen that is unbound and actually active in your body. This amount usually ranges from 0.3 to 5.62%. Women with PCOS often have an increased level of both total testosterone and free androgen levels. Furthermore, even a slight increase in testosterone in a woman’s body can suppress normal menstruation and ovulation. However, it is possible to have hirsutism and acne and have normal androgen levels in PCOS, therefore normal biochemical levels do not outrule PCOS.
Oral contraceptives will lower total testosterone, and interpretation in this setting is difficult (3 months off oral contraceptives is best to get a “true” testosterone value).
What is Dehydroepiandrosterone sulphate? (DHEAs)
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 4 – 11 umol/l.
DHEA-S values may be normal or slightly elevated in PCOS
What is sex hormone binding globulin (SHBG)?
Sex hormone binding globulin is a carrier protein in the blood that transports androgens and oestrogen. A low SHBG level is a sign of PCOS.
Low SHBG in PCOS is associated with common co-morbidities in PCOS, including:
- Abnormal glucose metabolism
- Abnormal lipid metabolism
- Hyperandrogenemia
- Insulin resistance
- Obesity
What is free androgen index?
Measurement of free androgen index is recommended for suspected hyperandrogenism in females.
What is TSH?
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 (0.35-5.5 MIU/L).
Thyroid stimulating hormone is secreted by the pituitary gland and regulates the release of triiodothyronine (T3) and thyroxine (T4). Having high TSH and low levels of T3 and T4 can cause menstrual changes similar to those experienced in PCOS and this is why it is important to check the thyroid hormones. Similarly an overactive thyroid gland will also cause menstrual irregularities.
Why is glucose, HbA1C and insulin measured?
Due to the recent research that PCOS is probably caused by insulin resistance, glucose levels are checked 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 (> 6 mmol/l) can indicate insulin resistance, a diabetes-related condition that contributes to PCOS.
Why is a lipid profile done?
There is a connection between PCOS and heart disease; therefore we 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 5 mmol/l. 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.
Women with PCOS tend to have less good cholesterol (HDL) with a high density lipoprotein < 1.28 nmol/l and more bad cholesterol (LDL). In addition, triglyceride levels, another component of cholesterol, tend to be high in women with PCOS (> 1.68 nmol/l) which further contributes to the risk of heart disease.
What is Anti-Mullerian Hormone (AMH)?
High levels of anti-mullerian hormone (AMH) are another sign of PCOS. AMH is a hormone that is released from immature antral follicles in the ovaries, these are the small fluid-filled cyst-like structures that can be seen on ultrasound.
AMH is believed to inhibit a follicle’s ability to mature into an egg (an oocyte). This can prevent ovulation, cause longer menstrual cycles and lead to infertility.
AMH is also used in fertility medicine as measure of the ovarian reserve (quantity of eggs remaining).
What is 17 hydroxyprogesterone?
The 17-hydroxyprogesterone bloodtest (17-OHP) detects a hormone made by the adrenal glands. It is involved in the production of the stress hormone cortisol.
The 17-OHP test is used to determine the presence of late-onset congenital adrenal hyperplasia another medical condition that can mimic the symptoms of PCOS.