So you’ve just been diagnosed with polycystic ovarian syndrome (PCOS)…now what!? For a lot of women, hearing this diagnosis can come with a ton of questions. Depending on the scenario, it also may feel like you don’t have a lot of options to support your condition and care other than the oral contraception pill (news flash, we can do SO much better than just offering up the pill). PCOS is metabolic and hormonal condition that affects women of all ages. PCOS is a lot more than just regulating cycles. Although one of the goals is to help support regular ovulation and menses, we also need to support metabolic health, mental health, gut health and screen for other conditions that we know can co-occur.

In order to be diagnosed with PCOS you must have met 2 out of the following 3 criteria:

Polycystic ovaries found on ultrasound. This is known as a “string of pearl” appearance and can be classified as 12 or more follicles within the ovary, with a diameter of 2-9mm, and/or an ovarian volume of 10 or more mL. A recent update to this criteria is using elevations to anti-Mullerian Hormone (AMH) instead of an ultrasound in adults only.

Signs of hyperandrogenism (unwanted hair growth, unwanted hair loss notably in the corners of the hairline or along in the midline, acne notably along the chin/ jawline) or elevations in androgens on blood work

Irregular menstrual cycles (frequent bleeding <21 days, infrequent bleeding of >35 days) amenorrhea (absence of periods), anovulation (lack of ovulation)

A typical hormonal work-up when assessing for PCOS often includes hormones from the brain such as LH and FSH, as we can see an elevated LH to FSH ratio in many types of PCOS. Your doctor will also typically measure total testosterone and free testosterone to assess for any elevations, and they may have ran an AMH which can become elevated due to an increased production from multiple immature follicles within the ovaries.

However, if you have PCOS you also want to investigate the following 5 markers which can dramatically change your treatment options and how you experience symptoms:

1. CRP

CRP is an acute marker of inflammation. In some scenarios, it can directly be related to inflammation coming from the gut. Chronic low grade inflammation is associated with PCOS and can impact how your body is signaling for insulin, how your hormones are functioning both at the level of the receptor but also in terms of signaling, your energy levels, weight regulation, and so much more. We know that people with PCOS are more likely to have an imbalance gut microbiome (gut dysbiosis) and this impacts whole body health. Assessing gut health and dysbiosis can be a key to managing your PCOS.

2. Thyroid Panel:

A full thyroid panel includes TSH which is the hormone from your brain signaling to your thyroid gland, active thyroid hormones including T4 and T3, and screening for thyroid antibodies including Anti-TPO and Anti-TG. We know that people with PCOS are at an increased risk for Hashimoto’s, the most common cause of hypothyroidism in women.

3. DHEA-S:

DHEA is an androgen hormone made predominantly by the adrenal glands which sit on top of our kidneys. This is important to assess in addition to testosterone when assessing for elevations to our androgen hormones. Predominantly for the “Lean-Type” PCOS we can see normal testosterone, but elevations to DHEA which can still impact androgen signs and symptoms in the body. Even though DHEA is also an androgen, how we support lowering DHEA vs testosterone can look different.

4. Vitamin D:

Vitamin D deficiency is extremely common in North America and can affect almost every reproductive health condition. Specifically, in PCOS, Vitamin D plays an essential role for regulating inflammation, insulin, and our hormones. Although a Vitamin, Vitamin D acts like a hormone itself throughout the body, and a deficiency in Vitamin D can exacerbate symptoms. Vitamin D is a fat-soluble vitamin, meaning we always want to assess baseline levels of Vitamin D status so we can ensure proper dosing to optimal levels (it is not a one size fit all dosing).

5. 2-Hour Insulin Glucose Challenge Test:

At the root of every type of PCOS there are changes to insulin and blood sugar regulation. How this presents can look different for different types of PCOS ranging from insulin resistance to insulin hypersensitivity, but it is a foundational part of being able to fully support the metabolic and hormonal challenges that come with this condition. Some practioners will assess blood sugar levels with an HbA1c, others may do a fasting insulin and fasting glucose test and then use those values to calculate an HOMA-IR score, which is a score of insulin resistance. However, the latter tests do not give us the most accurate data for assessing someone’s individual insulin response. The 2-hour Insulin Glucose Challenge test is the most thorough and accurate test for being able to assess an individual’s insulin response. Not only does it test fasting insulin and fasting glucose, but after drinking the glucose drink we are able to measure over the span of 2 hours (30 min, 60 min and 2 hour tests) insulin and glucose levels again to map out your individual response. This gives us the best data to assess for the severity of insulin resistance, or insulin pattern, and how best to build a treatment plan in supporting an optimal insulin and blood sugar response. By only measuring an HbA1c, or fasting insulin and fasting glucose we are missing a big piece to the puzzle. Insulin is a hormone that tells our body to burn or store energy, it impacts the enzymes which are involved in androgen production, it can directly contribute to acne and hair loss, and it also impacts ovarian function and menstrual regularity when out of whack, and when elevated can drive up inflammation and oxidative stress in the body.

Other metabolic tests that may be run include a fasting lipid panel which gives us information about cholesterol, and how it may be related to your insulin, a liver panel to assess for any changes to liver enzymes, and free fatty acids which can be a tie breaker when assessing different types of insulin patterns.

Laboratory tests are a crucial component in diagnosing and managing PCOS, and there are a lot of key pieces of information we can gather which helps to build a treatment plan specific to your body. There is PCOS treatment available.

PCOS is a condition which can look different for every person, even though technically it’s same diagnosis. For example, someone can have polycystic ovaries and high testosterone but regular cycles. They may have no polycystic ovaries but have irregular cycles and elevated androgens. Other women have irregular cycles and polycystic ovaries but no elevations in testosterone. Some women have weight loss resistance, others have a lean type of PCOS. Some women may have fertility challenges, while others have no difficulty with conception. Based on this variety, it’s essential that treatment and support is tailored to the type of PCOS you have, what your goals for health look like, and supporting those symptoms accordingly. Although there is no cure for PCOS, for many women with the proper support and treatment plan they can manage their condition and experience little to no symptoms. The key is in a proper assessment for the type of PCOS you have and building a treatment plan to support those pieces of the puzzle which may look like a combination of lifestyle changes, supplements, and or medications.

References:

Christ JP, Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics (Basel). 2023;13(6):1113. Published 2023 Mar 15. doi:10.3390/diagnostics13061113

Teede H, Misso M, Tassone EC, et al. Anti-Müllerian Hormone in PCOS: A Review Informing International Guidelines. Trends Endocrinol Metab. 2019;30(7):467-478. doi:10.1016/j.tem.2019.04.006