Testing and Treating PCOS: All You Need To Know

Since there is no single test that definitively diagnoses PCOS, oftentimes multiple symptoms, factors, and tests are taken together to come to a conclusion. So what tests should you know about? And if your physician does deliver a positive diagnosis, what are your options for treatment? These are just a couple of the questions we’ll be diving into for this post, so stay tuned!

  • Defining and Diagnosing PCOS
    • Criteria for diagnosis
  • Tests To Ask Your Doctor About 
    • Blood Testing 
    • Physical and Visual Exams 
    • Miscellaneous Tests
  • Evidence-Backed Treatments For PCOS
    • Nutrition 
    • Medications 
    • Supplements
    • Aesthetic Treatments

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 positive 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’s what you need to be diagnosed with PCOS

You must have 2 of the following 3 criteria, otherwise known as the Rotterdam 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. 

Tests you may want to ask your doctor about 

  • Hormonal blood testing

Some physical symptoms can indicate an imbalance of androgens (examples would be excess hair growth, hair loss, and acne), but to confirm, exclude other potential health concerns, or simply gain more insight into an effective PCOS treatment plan, your doctor may check more than just your testosterone. All in all, they may choose to check the following levels:

  • 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 
  • Follicle-stimulating hormone (FSH) 
    • Your FSH levels may be checked to rule out the possibility of primary ovarian failure. In patients with PCOS, FSH levels are usually within normal range or low, and the LH-FSH ratio may be greater than 3. 
  • Total and free testosterone 
    • Women with PCOS are known to have raised levels of testosterone which is responsible for excess hair growth and acne, as your skin cells and hair follicles are extremely sensitive to increased levels of this hormone. 
  • Dehydroepiandrosterone sulfate (DHEAS) 
    • DHEAS is secreted by the adrenal glands and is converted into either estrogen or testosterone. In women, moderately high levels of DHEAS are associated with hyperandrogenism, and around 20-30% of women suffering from PCOS have elevated levels of DHEAS. 
  • Androstenedione 
  • 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, in order 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). 
  • Other exams/tests 

Since PCOS is a collection of symptoms, with the exact underlying cause still unknown, an important part of the diagnosis process will be physical and visual exams. 

Some examples of further tests and exams your doctor may carry out, include: 

  • Pelvic exam 

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. 

  • Visual exam 

Your doctor may conduct this 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. 

  • Miscellaneous tests 

These can include checks of your blood pressure, a glucose tolerance test, as well as a cholesterol test, in order to get a holistic picture of your internal health. This can also be helpful in anticipating and avoiding potential complications associated with any treatment plans they may recommend. For instance, since spironolactone (a medication used off-label for treating hair loss and acne) has a big impact on reducing blood pressure, if you have low blood pressure already, this medication may be unhelpful or even dangerous for you to use. 

  • Mental health screening 

Your doctor may refer you to a therapist, or they may ask questions about your mental wellbeing. Unfortunately, there is evidence that PCOS is associated with a higher probability of being diagnosed with depression, anxiety, OCD, and bipolar disorder. Of course, correlation does not indicate causation, and this association is not prescriptive, but your mental health is definitely worth paying extra attention to during this time. Your doctor may have questions to check in with how you are doing, and gain more insight into how they can support you during this time. 

Treating PCOS 

Since there is no cure for PCOS, a more friendly approach to managing PCOS may focus on mitigating symptoms, as opposed to ‘fixing’ this condition once and for all. Indeed, managing your PCOS can be an ongoing, adaptive process that will look different during different times of your life. 

Let’s briefly touch on some common methods to treating 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 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 women 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!

Concluding thoughts 

If you believe you have PCOS, we highly encourage you to visit your doctor to understand what may be going on internally. Only once you identify what your body is trying to tell you can you begin trying to take steps toward healing and taking proactive steps toward protecting your long-term health and wellbeing.  

Allara provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.

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