Discover everything you need to know about hormone testing for PCOS, including the 10 most important markers we test for clients with PCOS or suspected PCOS.
First of all, what is PCOS?
PCOS stands for polycystic ovarian syndrome, and it is an endocrine-metabolic disorder that affects 4–20% of women worldwide. Some of the typical symptoms of PCOS include weight gain, irregular periods, head hair loss, excess body hair growth and acne.
PCOS is not in fact just one disease, but a disorder with different underlying factors. Typically it is defined as androgen excess (when all other causes of androgen excess have been ruled out). Diagnosing PCOS correctly is incredibly important and involves ensuring the right diagnostic criteria are met, otherwise there is a risk of misdiagnosis.
There are four types of PCOS – insulin resistant PCOS, inflammatory PCOS, adrenal PCOS and post-pill PCOS. It is vital to know which type you may have as it can change the way that your PCOS is addressed and treated. Hormone testing for PCOS can help you to understand the main drivers are for your PCOS and provide valuable information into your individual picture.
Hormone testing for PCOS
When considering the right PCOS treatment, we believe at FUTURE WOMAN that it is best to begin with testing. This is because testing helps our practitioners to determine the root cause of your hormone imbalances so they can then provide you with the most targeted and personalised supplement, diet and lifestyle recommendations.
Hormone testing for PCOS comes in many forms and it can be difficult to understand the differences between types of testing. Let’s begin by explaining how our FUTURE WOMAN dried urine hormone tests differ to other testing available via your GP.
A GP approach to testing with PCOS
Limited hormone testing for PCOS should be available via your GP.
Your GP has access to blood testing for PCOS and will often use these in conjunction with an ultrasound for an accurate diagnosis. The blood tests undertaken by your GP usually include:
- Luteinising hormone (LH) and follicular stimulating hormone (FSH)
- Prolactin (to rule out hyperprolactinaemia)
- Thyroid function tests like TSH to assess if the thyroid is a contributing factor to irregular periods
- Androgen levels via total serum testosterone, free testosterone level or the free androgen index (FAI).
Your GP may also test HbA1c to check your blood sugar levels over the last few months. This can suggest that there may be insulin resistance underlying your PCOS.
The FUTURE WOMAN approach to testing with PCOS
The blood tests mentioned above are important for diagnosing PCOS and to help your GP rule out other health conditions that might be impacting your hormones such as an underactive thyroid.
However, there are a few gaps that cannot be filled with blood testing alone. At FUTURE WOMAN we care about getting to the root cause of your PCOS, so we can personalise your treatment plan and help alleviate your symptoms.
For this reason, we prefer dried urine hormone tests for PCOS (rather than blood tests) because they have been shown to be more accurate and comprehensive than blood tests for hormones.
The key benefits of our urine tests for women with PCOS or suspected PCOS (that aren’t available via blood testing) are:
- Dried urine tests provide insights into not just your hormone production but also your hormone metabolism which is crucial for PCOS (more on this below); and.
- Dried urine testing allows us to identify other important contributing factors to your PCOS like stress or nutrient deficiencies.
hormone metabolites: Why they are so important for PCOS
It’s widely known that one of the key hormones that can be out of balance with PCOS is testosterone. Excess testosterone is a key driver of the symptoms of PCOS and can cause symptoms of excess hair growth, weight gain and acne.
But did you know that your symptoms may vary in intensity depending on which pathway your testosterone is being metabolised down? Depending on which pathway you favour, you may be more or less symptomatic.
- 5a pathway: This pathway is considered the more androgenic pathway and can be a root cause of your PCOS symptoms. This is because 5a reductase converts testosterone into something called 5DHT, which is more potent than testosterone.
- 5b pathway: This pathway is less androgenic and therefore less likely to result in symptoms such as acne and head hair loss.
This is an example of how important it is not to only understand your hormone levels but also how they are working and being processed in the body too.
Furthermore, your GP also does not typically test other key hormones like estrogen, progesterone, DHEA, or assess the dysregulation of the HPA axis (hypothalamus-pituitary-adrenal axis) which can be driving your PCOS. All of this is assessed in great detail in our FUTURE WOMAN advanced urine tests.
The 10 key markers to test for PCOS:
Androgens and their metabolites
In all three of our hormone tests we look at androgens and their metabolites. As mentioned above, most women who have PCOS have raised androgen levels. When androgens are raised in the body (as they are with PCOS) from overproduction in the ovaries or adrenal glands it leads to an increase in many symptoms. For example increased androgens can trigger head hair thinning on the head. This is because androgens can help to regulate hair follicle size and can actually inhibit the hair follicle when androgens are raised.
Our easy at-home urine tests can help to identify not only what is happening with your hormone levels, but how your hormones are being created and processed in the body too. Our hormone tests specifically look at:
1. DHEA and DHEA-S
DHEA and DHEA-S are predominantly made from the adrenal glands (DHEA-S is only made in the adrenal glands) and both are typically high in those with PCOS.
DHEA and DHEA-S are important to test in PCOS as they can convert to testosterone in the body’s tissues and therefore can be linked to many symptoms of PCOS.
It is important to note that DHEA is typically the only raised androgen in adrenal PCOS.
This is another marker that is vital to look at in PCOS. Androstenedione can convert into testosterone in the body leading to worsening of PCOS symptoms (it can also convert to estrogen leading to worsening PMS or heavy and painful periods).
3. 5a reductase and 5b reductase
If the body prefers the 5a pathways then this is considered the more androgenic pathway and can be a root cause of your PCOS symptoms. This is because 5a reductase converts testosterone into something called 5DHT which is more potent than testosterone.
On the other hand the 5b pathway is less androgenic and less likely to result in symptoms such as acne and head hair loss.
Of course it is important to look at testosterone in PCOS. This is typically raised in most women with PCOS (unless it’s adrenal PCOS). When testosterone is measured in our hormone tests we never look at it in isolation, it is looked at in conjunction with DHEA, androstenedione and 5a and 5b pathways to understand what is causing higher levels of testosterone.
Estrogen & its metabolites
It is important to take not only estrogen levels into consideration when looking at PCOS, but also estrogen production and metabolism too.
Estrogen can be low, normal or high in PCOS, depending on your own individual hormone picture. It can be common in PCOS to experience unopposed estrogen. This means estrogen is high in comparison to progesterone. This is common as progesterone is only made through ovulation and ovulation is often inhibited in those with PCOS. This can lead to symptoms such as mood changes, weight gain, heavier or more painful periods and more.
5. Overall estrogen
Estrogen is one of the two main female reproductive hormones (the other being progesterone). There are three main estrogens explained in your results.
Estrogen can be low, normal or high in those with PCOS. Interestingly even if you have low estrogen with PCOS, you are likely to have estrogen dominance, this means your estrogen is high in comparison to your progesterone.
Any imbalance between hormones can lead to worsening symptoms such as irregular cycles, lack of ovulation, heavy periods, painful periods, acne and more.
6. Estrogen metabolites
When we look at estrogen in our hormone tests we are also looking at estrogen metabolism, including phase 1 estrogen detoxification, phase 2 estrogen detoxification and methylation.
Poor estrogen metabolism can contribute to symptoms of unopposed estrogen such as PMS, painful and heavy periods.
In PCOS, there is no regular ovulation. This means there is likely to be very low progesterone levels as progesterone is only made as a result of ovulation.
Low progesterone levels can result in symptoms such as low mood, anxiety, heavy periods, irregular periods and poor sleep. Ovulation is triggered by a surge of lutenising hormone (LH), but in PCOS LH is often high and unwavering (due to poor pulsatility of gonadotropin releasing hormone). This high LH inhibits ovulation and results in missing or irregular periods.
Progesterone is a truly magical hormone (when it is in balance!). It is known for its calming and soothing effects, making us feel relaxed & balanced throughout the second half of your cycle, as well as also helping to improve memory, maintain a balanced endometrial lining and more. Although progesterone helps the body in many ways and is greatly beneficial for our health, it is only made in the body once you ovulate.
8. Progesterone metabolites
Measured in our hormone tests are the metabolites of progesterone – 5b-pregnanediol and 5a-pregnanediol. This can help to determine if you are ovulating, and if so, are you producing enough progesterone.
Typically blood tests only measure the b-pregnanediol pathway, which means that the a-pregnanediol can be missed. This is important as typically those with PCOS move their progesterone down the a-pregnanediol pathway.
The HPA axis and adrenal glands
Testing the hypothalamic-pituitary-adrenal axis (HPA axis) is vital when addressing PCOS. One of the reasons for this is because the hormones DHEA and androstenedione made by the adrenal glands can convert to testosterone and therefore can result in increased symptoms of PCOS. So assessing the communication between the brain and the adrenal glands is crucial.
Interestingly the root cause of PCOS can actually be traced back to the brain, in particular to the disruption of the HPA axis. A disrupted HPA axis can cause increased pulsatility of gonadotropin hormone, which can lead to increased pulsatility of luteinizing hormone (LH) which can in turn lead to irregular periods, lack of ovulation and increased testosterone (PCOS).
Therefore at FUTURE WOMAN we believe if you are addressing PCOS from a root cause level it is vital to look at the HPA axis through testing.
Here are two key markers that we look at when assessing the HPA axis.
9. metabolised and free cortisol and cortisone
It is important to test both free and metabolised cortisol and cortisone, as it can provide valuable information about a person’s stress response and HPA axis functioning. This is especially important in PCOS as increased cortisol can contribute towards increasing overall inflammation in the body which in turn increases testosterone production resulting in the worsening of symptoms.
10. Cortisol awakening response
In our Advanced hormone tests we look at the cortisol awakening response (CAR). This can be seen as a mini stress test as it provides valuable insight into your stress response across the day.
An elevated CAR result suggests that you may have an overactive HPA response which could be driving your PCOS.
Other key markers for hormone testing in pcos
We’ve now covered the 10 most important markers we assess for women with PCOS or suspected PCOS but there are many other markers that we also test in our Advanced and Advanced with Cycle Mapping Hormone Tests that are revealing. These include markers that look at oxidative stress, gut dysbiosis, glutathione levels, B6, B12 and neurotransmitter levels that may also be impacting your hormone health.
To conclude, if you have PCOS or you suspect you have PCOS, the Advanced or Advanced with Cycle Mapping Hormone test will provide you with comprehensive insights into your hormones to help address not only the symptoms you are experiencing but also to help establish the root cause.
If you’re interested in testing, take our 5 minute PCOS symptom checker and see which hormone test is right for you.