What Tests to Diagnose PCOS? | PYHP 062

PCOS Testing and Diagnosis: In this episode, we talk about the testing and labs for a diagnosis for PCOS. These testing and labs are also a good way to monitor PCOS.

Ultrasound: Checking for multiple cysts on or in the ovaries. It is still very common to have PCOS but have not cysts ( string of pearls ).

LH: FSH ratio:

• 2:1 or more

DHEA-S:

• DHEA-sulfate is the best way to test for DHEA levels in the blood.  
• DHEA-sulfate is a metabolite of DHEA and is much more accurate to determine DHEA levels than a total DHEA level.  
• DHEA levels are highest when we are young, around 25 years old. And will slowly decline with age. It is considered an androgen.
• The reference ranges for DHEA-Sulfate are very vast and are based on age. For example, a woman that is 35 years old gets her blood drawn for DHEA-sulfate. The reference ranges for a typical lab is 23-266 mcg/dL.  
• For a female that has PCOS around 35 years of age, you will see the DHEA-sulfate at 200 or above. 
• Commonly PCOS, the DHEA-s will show over 200 mcg/dL.  

Testosterone:

• The reference ranges for testosterone labs are huge.  
• Quest has a reference range of 2-45 ng/dL.  
• LabCorp has a reference range of 8-48 ng/dL.  
• Testosterone levels at 35 or higher

Estrogen

• Three circulating estrogens: Estrone, Estradiol, Estriol

Vast reference typical reference ranges for most labs:

• Follicular Phase 19-144pg/mL
• Mid-Cycle 64-357
• Luteal Phase 56-214
• Postmenopausal
• These are large reference ranges and do not tell you a lot.
• In PCOS the estrogen levels do not fall much and may actually be elevated.

Progesterone:

• It is very common to have low levels of progesterone in PCOS. 
• Ignore the typical lab reference ranges, which are huge:
• Follicular Phase<1.0ng/mL  
• Luteal Phase2.6-21.5ng/mL  
• Postmenopausal<0.5ng/mL
• Let’s say you are having regular periods and have your blood work done between days 16-25. 
• If the less than 1 ng/mL then that woman is not ovulating and we need to work on the progesterone levels. As it is common to have low progesterone in PCOS.   
• If the progesterone is 4-8 ng/mL, then tha...