Lab Testing for PCOS

Lab Testing for PCOS

Polycystic ovarian syndrome (PCOS) affects up to 20% of women during their reproductive years, making it the most common hormonal disorder. Unfortunately, PCOS is often underdiagnosed, and an accurate diagnosis can take years and visits to many medical providers. Even when a receives an accurate diagnosis, conventional treatment focuses on treating the symptoms and doesn’t examine the root causes, leaving many women with unaddressed concerns.

An integrative and functional medicine approach to PCOS goes beyond diagnostic testing and aims to uncover what’s driving hormonal imbalances. Instead of masking symptoms and only relying on pharmaceuticals, we dig deeper to uncover the specific imbalances contributing to the condition. With this extra layer of information, we can treat each woman’s PCOS individually and effectively.

A cornerstone of the integrative approach is lab testing. We use many conventional lab tests and specialty functional medicine tests for a complete assessment of each woman. Today’s article will review some of the tests we use at TārāMD with our PCOS patients. Keep reading as we explore:

• What is PCOS?
• PCOS diagnostic testing
• Additional testing, including functional medicine labs
• PCOS action steps and working with TārāMD

What is PCOS?

PCOS is a chronic endocrine disorder affecting metabolic and reproductive health. PCOS causes a range of symptoms including:

• Irregular menstrual cycles
• Absent menstrual cycles (no ovulation)
• Thinning hair on the head
• Hair growth on the face and chest (hirsutism)
• Skin changes, often oily skin and acne
• Fertility challenges
• Weight gain and weight loss resistance

It’s not just the PCOS you need to worry about. Over time, the hormonal imbalances associated with PCOS increase the risk for:

• Infertility
• Miscarriage
• Adverse pregnancy outcomes
• Cardiometabolic disease
• Psychological issues, including depression, anxiety, disordered eating
• Cancer
• Sleep apnea

Read more about PCOS here.

PCOS Diagnostic Testing

For a diagnosis of PCOS, a woman must meet two of these three criteria:

1. Menstrual irregularities – inconsistencies between menstrual cycles or absent (anovulatory) cycles. There isn’t a test for this, but it can be determined by tracking the menstrual cycle and associated symptoms.

2. Clinical or Biochemical Hyperandrogenism – either high androgens on lab work (such as DHEA, testosterone, and DHT) or symptoms of high androgens, such as hirsutism and acne. Read about androgen excess in depth in this article.

3. Polycystic ovaries – many cysts on the ovaries as determined by an ultrasound.

Along with PCOS testing, you may have other testing to rule out other diagnoses. Although rare, it’s important to rule out tumors, hyperprolactinemia (high prolactin), Cushing’s syndrome or other potential causes of the symptoms.

Integrative and Functional Testing

The integrative approach we take at TārāMD goes beyond the PCOS diagnosis. We want to understand why PCOS developed and what’s driving it. Obtaining this next layer of information informs our treatment plans to effectively manage symptoms and support healthy hormone balance and individual health goals, such as fertility, chronic disease prevention, and longevity.

This deeper exploration of PCOS may involve additional blood tests and specialized functional testing. Let’s look at some of the tests we use in our practice.

DUTCH Testing

Estrogen and progesterone are the primary hormones that regulate the menstrual cycle, and irregular or absent menstrual cycles are a hallmark of PCOS. Estrogen dominance, low progesterone (because of not ovulating), and even changes in estrogen receptors are common in women with PCOS.

The DUTCH Test (Dried Urine Test for Comprehensive Hormones) is a functional test that comprehensively examines steroid hormones. It allows us to look at:

• Estrogen levels (E1, E2, and E3)
• Estrogen metabolites (estrogen detoxification in the liver)
• Progesterone levels (and progesterone metabolites)
• Testosterone, DHEA, and other androgens (and androgen metabolites)
• Cortisol and metabolites (give us information about the adrenal stress response)
• Melatonin (sleep hormone)
• Additional markers for critical nutrients, neurotransmitters, inflammation, and oxidative stress

Comprehensive Stool Test

We must recognize the significance of gut health when it comes to hormonal and metabolic conditions, and PCOS is no exception. The gut microbiome plays a significant role in women’s health. It shapes calorie-burning metabolism, helps clear excess estrogen (or allows it to recirculate), and can be a source of chronic inflammation that promotes disease.

Dysbiosis (gut imbalances) may be a root cause of PCOS. One theory suggests that a poor diet creates dysbiosis causing intestinal permeability (leaky gut), which allows larger proteins and toxins to enter circulation. This gut dysfunction triggers an overactive immune system, which alters insulin and androgens and interferes with follicle development in the ovaries, giving rise to collection of symptoms seen in PCOS. Further, if you have PCOS, you may also experience digestive distress and other symptoms associated with dysbiosis and leaky gut.

A comprehensive functional stool test is one of the best ways to assess for dysbiosis, gut infections, leaky gut, and other markers that may play a root cause role in PCOS. Your TārāMD provider can use the results to help you balance and heal the gut microbiome, improving hormonal health, digestion, and overall wellness.

Full Thyroid Panel

Women with PCOS have a high prevalence of thyroid imbalances. Additionally, PCOS and hypothyroidism have similar symptoms. Thyroid imbalances are also more likely to occur during times of hormonal change. Read more about the PCOS-thyroid connection here.

Have you ever had your TSH tested and been told your thyroid is normal? Even when TSH levels are within the (wide) lab range, thyroid imbalances are still possible. That’s why, from an integrative medicine lens, we want to look at the whole picture of thyroid health with a complete thyroid panel that includes:

• TSH
• Free and total T4
• Free and total T3
• Reverse T3
• Thyroid antibodies (thyroglobulin and TPO)

Additional Blood Labs

As part of a root cause workup from an integrative perspective, here are some labs to consider:

• FSH (follicle stimulating hormone) – stimulates the growth of egg follicles in the ovary

• LH (luteinizing hormone) – triggers ovulation, the release of a mature egg from the ovary. The LH:FSH ratio can be elevated in PCOS.

• SHBG (sex hormone binding globulin) – a transport protein that binds to androgens (including testosterone) and estrogen. Low SHBG levels are associated with insulin resistance and PCOS, contributing to higher levels of androgens and estrogen.

• AMH (anti-Mullerian hormone) – released by follicles in the ovaries and a marker of ovarian reserve. Levels can be high in PCOS because of higher follicle numbers and may play a role in anovulation.

• Fasting insulin – a marker of insulin resistance often associated with PCOS. We may check hemoglobin A1C (a 2-month blood sugar average) or do an oral glucose tolerance test (OGTT) for more information about blood sugar.

• Lipid panel – a standard test that is important to monitor in PCOS as lipid imbalances, including high cholesterol, are common with PCOS and promote inflammation. We can look at an advanced lipid panel (NMR lipoprotein analysis) for more comprehensive information.

• Vitamin D – an essential vitamin/hormone for immunity, bone health, glucose metabolism, genetic expression, and more. Vitamin D deficiency correlates with PCOS hallmarks such as insulin resistance, high androgens, and ovarian dysfunction. Most patients are deficient in vitamin D and require personalized supplement dosing.

Key Takeaways and Next Steps

Both conventional and functional labs are a cornerstone of the integrative and functional medicine approach to PCOS. These are just some of the labs that help us understand PCOS’s root causes and lead to more precise and personalized treatments.

As we collect more data and understand each woman’s history and symptoms, we can build upon the foundations and fine-tune your nutrition, exercise, supplement, stress management, and medication plan. Our goal is to move beyond symptom management to optimize your health so you can have and do all the great things you desire with your life.

To discover how we can help you with PCOS and other women’s health concerns, contact TārāMD today.

References

1. Dason, E. S., Koshkina, O., Chan, C., & Sobel, M. (2024). Diagnosis and management of polycystic ovarian syndrome. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 196(3), E85–E94.
2. https://emedicine.medscape.com/article/256806-workup
3. Xu, X. L., Deng, S. L., Lian, Z. X., & Yu, K. (2021). Estrogen Receptors in Polycystic Ovary Syndrome. Cells, 10(2), 459.
4. Tremellen, K., & Pearce, K. (2012). Dysbiosis of Gut Microbiota (DOGMA)--a novel theory for the development of Polycystic Ovarian Syndrome. Medical hypotheses, 79(1), 104–112.
5. Palomba, S., Colombo, C., Busnelli, A., Caserta, D., & Vitale, G. (2023). Polycystic ovary syndrome and thyroid disorder: a comprehensive narrative review of the literature. Frontiers in endocrinology, 14, 1251866.
6. Saadia Z. (2020). Follicle Stimulating Hormone (LH: FSH) Ratio in Polycystic Ovary Syndrome (PCOS) - Obese vs. Non- Obese Women. Medical archives (Sarajevo, Bosnia and Herzegovina), 74(4), 289–293.
7. Xing, C., Zhang, J., Zhao, H., & He, B. (2022). Effect of Sex Hormone-Binding Globulin on Polycystic Ovary Syndrome: Mechanisms, Manifestations, Genetics, and Treatment. International journal of women's health, 14, 91–105.
8. Bhide, P., & Homburg, R. (2016). Anti-Müllerian hormone and polycystic ovary syndrome. Best practice & research. Clinical obstetrics & gynaecology, 37, 38–45.
9. Zhou, X., Tian, Y., & Zhang, X. (2024). Correlation and predictive value of systemic immune-inflammation index for dyslipidemia in patients with polycystic ovary syndrome. BMC women's health, 24(1), 564.
10. Morgante, G., Darino, I., Spanò, A., Luisi, S., Luddi, A., Piomboni, P., Governini, L., & De Leo, V. (2022). PCOS Physiopathology and Vitamin D Deficiency: Biological Insights and Perspectives for Treatment. Journal of clinical medicine, 11(15), 4509.