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What Tests Should Be Done If PCOS is Suspected?

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As PCOS is not a particularly well known problem, despite it affecting as many as 1:10 women, many doctors may not have heard of it, what tests are appropriate to determine it’s presence and how to treat it effectively.
Although every woman is different and will have different needs, a basic list of tests that will be appropriate for most are set out here as a starting point:
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ULTRASOUND

Trans abdominal and transvaginal ultrasound of the pelvis.  This will be able to evaluate whether the ovaries are of a normal size or not, whether they contain cysts or not and the condition of the endometrium.
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GLUCOSE & INSULIN LEVELS
  • 2 hr Glucose Tolerance Test (GTT) including insulin levels and an glycosylated haemoglobin or HbA1c test
    • It is very important to check insulin levels as well as blood sugar levels at the beginning of the test prior to consumption of the glucose challenge and at 1 hour post and 2 hours post consumption of the glucose challenge.  If the blood sugar level it abnormal in any way at the 2 hour mark, or insulin levels are rising compared to the 1 hour test, then the test should be extended with testing continued on an hourly basis until all results are within the normal limits.  It is common for women with PCOS to have a GTT which can be incorrectly interpreted by an inexperienced pathologist or physician as normal if blood sugar levels are very low at the 2 hour mark or if they fail to measure insulin levels during the test.  This is probably the most important test as it determines the current degree of insulin resistance, which current research indicates is the reason behind many of the symptoms of PCOS.

HORMONES

  • Serum Sex Hormone Binding Globulin (SHBG)
  • Free Androgen Index (FAI)
  • Testosterone
  • Dihydrotestosterone (DHT)
  • Serum Dehydroepiandrosterone Sulfate or (DHEAS)
  • Prolactin
  • LH
    • It is important to note what day of your menstrual cycle you are on when the blood is taken for LH, FSH, Serum Progesterone and Serum Oestradiol as these hormones fluctuate in a specific pattern depending upon where you are in your cycle.  Cycle Day 1 (CD1) is the first day of your menstrual period, when your flow is reasonably heavy and consistent (not spotting).
  • FSH
  • Serum Progesterone
  • Serum Oestradiol
  • Thyroid Function Test (TFT including TSH and free T3 and T4) as well as Thyroid Autoimmunity studies (Tg Ab, antiTPO antibodies)
    • Thyroid problems are very common in women with PCOS and many of the symptoms of hypothyroidism are similar to those of PCOS.
  • Vitamin D (over 70% of women with PCOS are deficient in Vitamin D.  The most accurate test to have performed is the ’25(OH)D or 25-hydroxyvitamin D test as this is the active form of vitamin D.)

INFLAMMATORY MARKERS

  • C Reactive Protein (CRP)
    • This is an inflammatory marker.  Women with PCOS commonly have an increased level of inflammation within their bodies and this can be a risk factor for other chronic diseases.
  • ESR
    • An elevation in Erythrocyte Sedimentation Rate (ESR) is a nonspecific marker of inflammation and a finding in many diseases, so it is not by any means specific to PCOS.  It is however commonly found in PCOS as well as in subclinical hypothyroidism, an problem which is also more commonly found in women with PCOS than the general population.

GENERAL PATHOLOGY

  • Full Blood Count (FBC)
    • Not specific to PCOS, but always useful to know whenever you are having blood tests performed as it is a good indicator of overall health.  The number, size, shape, ratio and certain characteristics of the different types of blood cells can provide a great deal of insight into the general health of a human being.
  • Triglycerides
  • HDL, LDL and total cholesterol levels
    • Women with PCOS commonly have elevated triglyceride levels (the amount of fat in the blood) and LDL cholesterol (the bad kind), or an unfavourable LDL:HDL cholesterol ratio which is of far greater importance than the total cholesterol level.

The results from these initial tests should give you and your doctor a basic understanding of what you are dealing with.

If you are concerned that you may not be ovulating, or you wish to know whether you are or not, a series of LH and FSH tests performed throughout one menstrual cycle should help to clarify the issue.

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