How To Test For PCOS (And What To Expect)

The question of “how to test for PCOS” is a bit more complicated than first meets the eye.

But let’s rewind for a second. What is PCOS, exactly? PCOS stands for polycystic ovary syndrome, and it’s a hormonal disorder that’s relatively common in women of reproductive age (the CDC estimates around 1 in 10 women have it). Although the cause is still unknown – more research needs to be dedicated to this area of women’s health in particular – most experts believe it is most likely related to androgen excess and insulin resistance, and the way these two cofactors interact, potentially exacerbating each other.

But unfortunately, for many women, meeting with a healthcare professional and receiving a certain ‘yes’ or ‘no’ on whether you have PCOS is anything other than clear-cut. There are a myriad of reasons for this, but an important thing to know in advance of seeking out answers is that because there is no one checkbox you need to fill in order to receive a PCOS diagnosis, it can be difficult to get a conclusive answer. Instead, a positive PCOS diagnosis is often a result of assessing multiple symptoms and criteria, and tests such as blood tests are just a piece of this overall picture that doctors and other healthcare professionals will try to capture.

That being said – here’s some of what you can expect when you go through the process of being tested for PCOS.

Defining and Diagnosing PCOS

PCOS is, at its heart, a hormonal and metabolic disorder that disrupts your metabolic system, as well as your reproductive system. Physical symptoms like unexplained weight gain, hormonal acne, infertility issues, excess hair growth on the body, and androgenic alopecia (thinning hair on the head), are all highly distressing and can play a role in eventually identifying and diagnosing PCOS.

We’ve gone into more depth regarding the exact criteria for a  PCOS diagnosis (although it may differ slightly from provider to provider, so it is always best to get a second opinion if you are still unsure), but here are some criteria for a PCOS diagnosis. 

The Rotterdam criteria requires that  you must have 2 of the following criteria.

• Irregular periods (also called oligomenorrea) or no periods (amenorrhea)
• If you are on birth control, chances are you won’t ovulate and have a regular period (but rather a withdrawal period). Check out our article on how birth control affects your period for more information.
• Higher levels of androgens present in the blood (hyperandrogenism)
• Higher than typical levels of testosterone can be an indicator of PCOS, and is often responsible for physical symptoms like androgenic alopecia and acne.
• Polycystic ovaries visible on an ultrasound.

As you can see, some of these criteria (and above symptoms), are able to be tested in a lab setting to search for irregularities and give more insight as to what may be going on internally. So let’s talk about the types of testing available that may assist in reaching a consensus on whether you have PCOS, and if yes, what steps you can take to manage it more effectively.

A Closer Look At How To Test For PCOS

1. Medical exam

The first stop on your PCOS journey is to see your doctor.

Your primary health care provider will assess you to see how many, if any, symptoms of PCOS you display. They may also ask you questions about your symptoms such as when they began, whether they’ve gotten worse or stayed consistent over time, as well as inquiries about your medical history.

There are many symptoms of PCOS (which is why we have an entire article dedicated to common side effects of PCOS, as well as a special diagnostic visit), but here are some of the most notable symptoms most women experience:

• Weight gain
• This is a common finding thanks to the insulin insensitivity that accompanies the majority of women PCOS.
• Women with PCOS seem to have reduced insulin sensitivity, by an average of  35-40%, compared to women without PCOS, according to one study. This means for women with PCOS that insulin levels need to increasingly rise in order to get sugar into their muscle cells, but as the body becomes more and more desensitized to insulin, the body needs to create more of it to get cells to open. This eventually leads to a build up of sugar (otherwise known as glucose) in the blood, which in turn can make it harder to lose weight and put women with PCOS at increased risk of type 2 diabetes. Check out our article on everything you need to know about sugar and PCOS for more information on this topic, written by our Registered Dietitian, Felice. It covers everything from sugar cravings, to how insulin resistance develops, to practical advice on what to do to reduce your intake of high-sugar meals and snacks in a sustainable way.
• Acne
• Thought to be triggered by excess levels of androgens such as testosterone, acne is a common side effect with physical and emotional implications, as many women report feeling distress, shame, and even depression as a result of stubborn acne.
• Excess hair growth
• Also known as “hirsutism,” this symptom is again thought to be the culprit of too-high androgen levels. This excess hair growth is often found on the face, chest, and back, and is a common manifestation of PCOS.
• If this hair growth does bother you, there are medications which may help. Also electrolysis and laser treatment are accessible solutions which can be permanent (or at least long-lasting).
• Irregular or no period
• The menstrual cycle begins from the first day of your period to the first day of your next period, with the average menstrual cycle hovering around the 28 day mark. Menstrual flow occurring every 21 to every 40 days is considered normal, with a flow that lasts two to seven days. For the first few years after menstruation, longer cycles are common (as is irregularity), but tend to shorten and become more regular as one ages.
• If you get your period more often than every 21 days, or you go longer than 40 days between periods, then that is considered irregular.

An important note here on understanding if your period is regular or not, since this is often a question doctors will ask when reaching a PCOS diagnosis. If you don’t know when you get your period – don’t panic! Many women often don’t take a closer look at their periods until they are trying to conceive, or they come off of hormonal birth control. It’s worth pointing out here that if you are on an oral contraceptive, or another type of hormonal birth control, you won’t have a period each month. This can be somewhat surprising if you didn’t already know this, especially since many pills do offer a 7 day ‘break’ in which you bleed for several days. In fact, this is a breakthrough bleed, which is not a period.

On hormonal birth control (this excludes contraceptives like vaginal sponges, female condoms, and the copper IUD), you will not get a period since you do not ovulate. To know if you have regular periods or not, you would need to come off of hormonal birth control and track spotting, bleeding, and so on. To help you track, there are apps (such as Period Tracker, Clue, and Flo), many of which are free. The flow of your period also matters, so keeping track of how much you’re bleeding (women with PCOS tend to get heavy periods, when they arrive, as a result of low levels of progesterone) can be done by using a menstrual cup, or counting how many tampons and pads you use. An average amount of blood to lose on your period is between 30ml to 40ml, but it can be up to 60ml.

Now that we’ve covered symptoms and tracking your period, let’s examine some common questions a physician may ask to discover if PCOS is a likely root cause of some of your symptoms:

• When was your last period?
• If you have noticed weight gain, when did it begin?
• Have you found anything that improves or worsens your symptoms?
• Are you trying to become pregnant?
• Have any of your family members been diagnosed with PCOS, or displayed symptoms of PCOS?

Because there are multiple symptoms of PCOS, it’s a good idea to keep a journal (or even take notes on your phone) to keep track of any body changes. This way, you can try to be as objective as possible and gauge the state of your symptoms over a defined period of time. You can then share this information with a chosen healthcare professional in order to gain a deeper understanding of what is going on in your body.

It’s also important to remember that no two cases of PCOS are exactly the same: your biology is unique, and so the way that PCOS manifests itself may be different for you than it will be for a friend, a family member, or anyone online. Give your doctor as much detail as possible regarding potential symptoms, so that they can build a full picture as to what is going on internally.

2. Hormonal blood tests

Blood tests will help decipher whether you have PCOS, as they can lend more insight into the state of a hormonal imbalance in your body.

Follicle-stimulating hormone (FSH)

FSH is made by your pituitary gland, and if you have PCOS, your level may be lower than normal The FSH test is different from a regular CBC test that may be conducted as part of an annual physical exam; the FSH test is often used to help diagnose symptoms that indicate a hormonal imbalance or thyroid issue.

Testosterone

Since androgen excess (worsened by insulin resistance) can be the culprit or unwanted symptoms such as excess body hair, acne, and hair loss, this test result may be higher than normal If that is the case, there are steps you can take to try to balance your androgen levels, which may include reducing your artificial sugar intake, incorporating ‘androgen antagonists’ (such as green tea) into your diet, and pursuing other holistic medicines. There are also anti-androgen medications available, if you are open to prescription solutions.

Luteinizing hormone (LH)

Women with PCOS have high levels of LH secretion, which can contribute to high levels of androgens. This, along with low FSH levels, can contribute to poor egg development and a consequent lack of ovulation In women without PCOS, the ratio of LH to FSH is usually 1:2, but for women with PCOS, it may be 2:1 or even 3:1.

Estrogen

Since PCOS is characterized by excess androgen levels, you may expect this to be lower in women with PCOS, but surprisingly it is the opposite: women with PCOS often have high estrogen levels and insufficient progesterone, which prevents ovulation (and thus missed or irregular periods).

3. Glucose and cholesterol tests

This may come after you’re diagnosed with PCOS, but it is a key part of the PCOS journey: understanding how polycystic ovary syndrome is affecting you internally, as well as externally.

Here are a couple of popular tests that may be conducted to understand the effects of PCOS on your long-term health.

Lipid profile

Lipid profiles check your cholesterol and triglycerides. Cholesterol is a form of fat we need, but like with most things, there are “good” and “bad” forms of this fat. Low-density lipoprotein (LDL) is the ‘bad’ type which can stick to blood vessel walls, and over time, it can clog arteries, leading to blood clots and heart attacks.

Triglycerides are another type of fat that doctors take into account when cholesterol testing. High levels of triglycerides can increase your chances of heart attack or stroke, especially if you have low levels of “good” cholesterol (otherwise known as high-density lipoprotein, HDL). High triglyceride levels can suggest an increased risk of diabetes, which is important in women with PCOS, since due to increased insulin-insensitivity, they are vulnerable to being diagnosed with type 2 diabetes later down the line.

Glucose test

Glucose tests are useful for helping figure out if you have diabetes. As mentioned before, women with PCOS are at increased risk for type 2 diabetes: one study, conducted in 2017 in Denmark, found that women with PCOS were 4 times more likely to be diagnosed with PCOS than women without PCOS, and they would also be diagnosed with the disease 4 years earlier on average.

Insulin test

Here, your doctor will want to see how your body reacts to insulin. Since insulin insensitivity is such a driving force behind PCOS, it’s important for doctors to understand as much as possible about your blood sugar levels. Usually insulin tests take the form of:

• Fasting plasma glucose test

This measures your blood sugar after you haven’t eaten for a minimum of 8 hours.

• Oral glucose tolerance test

First, you take the fasting glucose test, and then you’ll drink a sugary solution. 2 hours later, you’ll take another blood test.

• Hemoglobin A1c test

This blood test shows your average blood sugar levels for the past 2 to 3 months. Doctors use it to diagnose prediabetes or diabetes.  

4. Ultrasound exam

We dive deep into what to expect from an ultrasound, what role they play in diagnosing PCOS, and how they work, here, but for brevity’s sake in this article, let’s just say they can be really important in the process of testing for PCOS.

Surprisingly, on an ultrasound, though cysts will likely be noted, what your healthcare provider will be looking for is the presence of follicles. These may look different in women with PCOS compared to women without it, thanks to anovulation, which means that these follicles – which contain egg cells – oftentimes do not ultimately mature and get released from the ovaries during ovulation (since many women with PCOS do not ovulate regularly or at all).

So what happens during this ultrasound? Well, the first thing to know is that if you and your physician agree on an ultrasound exam, you will have a transvaginal ultrasound. This is different than the type conducted for checking progress during a pregnancy, since it involves an ultrasound probe being placed in the vagina. This may sound like an invasive, potentially scary, procedure, but rest assured it is more uncomfortable than painful, and it does not take much time.

Here’s a snapshot of what you can expect on the day, and what your technician will be looking for:

• Your doctor may request beforehand that you drink up to 42 ounces of fluid, to fill your bladder, which will make it easier to see your ovaries in the 2D imaging.
• An ultrasound technician will use the ultrasound to take measurements and pictures to share the results with your healthcare provider.
• The sonographer will also likely not just examine your ovaries, but also examine your uterus and cervix as well. The number of follicles detected on your ovaries will be counted as part of an AFC (antral follicle count).
• Explain the process of pelvic and visual exams for detecting physical manifestations of PCOS.

5. Pelvic exams

During a pelvic exam, your doctor will seek to evaluate your reproductive organs for any masses, growths, or abnormalities. They may press down on your abdomen while inserting two gloved fingers inside your vagina in order to check your uterus, ovaries, and other pelvic organs.

6. Visual exams

Your doctor may conduct visual exams alongside your blood tests, or as a replacement in some circumstances, but typically this includes checking for physical manifestations of PCOS.

In particular, cystic acne that is persistent, hair growth on the chest, breasts, and face, hair loss on the top of the scalp, darkened patches of skin around the groin and underarms, as well as oily skin can all be indicators of PCOS.

After the diagnosis: Treatment options for PCOS

Medication

Metformin (has the ability to improve insulin resistance and lower insulin levels), spironolactone (used off-label for reducing acne and potentially treating hair loss), and clomiphene (described as an “anti-androgen” medication, it is designed for use during the first part of your menstrual cycle) are all potential medications your doctor may discuss with you.

For some, these medications are invaluable, while for others they want to take a more ‘natural’ approach to treating PCOS. Whatever you decide is a very personal choice, to be made between yourself and your doctor. And remember – if you are uncertain about treating your PCOS using these methods as a ‘frontline method’, you can always focus on the other treatment options to be discussed, and turn to medication as a last resort.

Supplements

Zinc and magnesium are examples of two fantastic supplements that can work wonders for reducing PCOS symptoms, with very few side effects. Just remember when opting for supplements to purchase those that note they are USP-certified or NSF-certified on the label.

This indicates they have been repeatedly tested to verify that what is advertised on the bottle is what is actually in the bottle.

If they don’t have either of these certifications – move right along! It is imperative you know that the quantities and ingredients listed on the bottle are what you are consuming (something which sadly can’t be guaranteed, since the FDA does not regulate the safety of supplements).

Nutrition

Nutrition can be critical in not only managing PCOS symptoms, but also giving your body more of what it needs so you can feel better in your everyday life.

For instance, certain vitamins and nutrients (found in food, supplements, or in some cases both) have the power to ease common PCOS symptoms. Foods that help you avoid sugar highs and crashes, as well as negative long-term health implications, can also be incredibly beneficial in reducing inflammation in the body, reducing fatigue, and also battling physical symptoms.

The power of a good, balanced PCOS diet and lifestyle adjustments is not to be underestimated. Learn more about what a PCOS plate might look like, here.

Aesthetic solutions

Laser hair removal, waxing, shaving, and electrolysis are just a few of the beauty treatments on the market for dealing with excess hair growth.

Minoxidil and finasteride are also topical solutions used to tackle (or at least stop, or slow) hair loss from androgenic alopecia. Check out our article exclusively dedicated to exploring hair loss treatments for a more in-depth discussion on this topic.

As an aside, here: since these symptoms can be psychologically distressing for women with PCOS, and temporarily ‘fixing’ excess hair growth can pale in comparison to complex feelings about the origins of this hormonal disorder (and all the physical reminders accompanying it), using these treatments may also be best used in conjunction with a trusted therapist. 

Leaning on a trusted community of people who also have PCOS can prove beneficial in asking questions, gaining advice, and feeling you have people who truly get it, when it comes to managing PCOS.

Exercise

We really can’t overstate the value of exercise in managing PCOS symptoms, fortifying one’s mental health, and strengthening your long-term health outcomes compared to individuals that don’t exercise. Since we’re talking about the efficacy of exercise in mitigating PCOS symptoms, let’s focus on that for now: anaerobic exercise is known to reduce insulin resistance (something that accompanies PCOS a lot of the time), as well as increasing metabolism.

So what type of exercise should you prioritize? Really, whatever exercise you’re likely to engage in regularly and stick to. The USDA suggests “anaerobic exercise”, otherwise known as a weighted workout. This may sound intimidating at first, especially to those who may not have exercise already incorporated into their daily routine, but weighted exercise can be accessible and customizable depending on your goals, abilities, and any potential injuries. For instance, jump-roping is a fun (and inexpensive) way to implement anaerobic exercise into your morning routine; you may also want to check out weightlifting (there are plenty of resources detailing alternatives to popular poses for those with knee injuries, such as a wall pose as opposed to the traditional squat pose).

As a bonus, exercise is also thought to be beneficial to your mental health – in particular, alleviating depressive and anxious feelings. We call that a win-win!

How To Test For PCOS – The Ongoing Debate

As you can see, a polycystic ovary syndrome evaluation is less of a rigid checklist that health care providers measure patients against, and more of a complicated, dynamic chronic condition that involves symptoms that have the ability to change over time. This is further reflected in the fact that the debate around how to test for PCOS is still being discussed among experts themselves.

For that reason, if you’re not sure about your doctor’s diagnosis, we absolutely encourage you to get a second opinion. This is something we can help with at Allara as well. When it comes to your health, there’s no such thing as being too big of an advocate for yourself.

Allara Health provides personalized treatment for hormonal, metabolic & gynecological conditions that utilizes a holistic plan that merges nutrition, lifestyle, medication and supplementation, and ongoing, expert support to heal your body.