PCOS: which tests to ask your doctor for?
Updated
In short
To explore PCOS, doctors rely on a hormone blood test (testosterone, SHBG), sometimes an ultrasound or an AMH test, and tests to rule out other causes (thyroid, prolactin). A fasting blood sugar test and a cholesterol check are also recommended. On hormonal birth control, hormone tests aren't reliable.
Tests to talk about
- Hormone blood test: testosterone and SHBG, ideally early in your cycle if you have periods.
- Pelvic ultrasound or AMH test, depending on your age.
- Thyroid (TSH) and prolactin, to rule out other causes.
- Fasting blood sugar and cholesterol, even if you're slim.
The birth control trap
On hormonal birth control, hormone tests aren't reliable. Guidelines usually suggest waiting 3 months after stopping, using non-hormonal contraception. Don't stop anything without talking to your doctor.
How the diagnosis is made
It takes 2 out of 3 criteria: irregular cycles, signs or high levels of androgens, polycystic-looking ovaries on ultrasound (or a high AMH). And other causes must be ruled out.
What to say at your appointment
"For [how long], I've had [your signs]. Could this come from a hormonal issue, and which tests can you order?"
Frequently asked questions
Do I need to fast?
For blood sugar and cholesterol, usually yes. Your lab will tell you.
Does a high AMH mean PCOS?
Not on its own. In adults it can replace the ultrasound, but the diagnosis needs 2 out of 3 criteria.
My tests are normal, but I have signs. Now what?
The diagnosis can be made from your signs and cycles, even with normal levels. You have the right to a second opinion.
Sources
- Teede et al., Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS, Human Reproduction, 2023
- Monash University, 2023 International PCOS Guideline
- World Health Organization, PCOS fact sheet
- Inserm, Syndrome des ovaires polykystiques (SOPK)
- NHS, Polycystic ovary syndrome (PCOS)
This guide informs; it does not diagnose and does not replace medical advice. Information from the international PCOS guidelines (2023) and the WHO.