The PCOS Hormones




Author: Ashley Levinson CMA,CST, CSFA
Social Media: @PCOSgurl

Since PCOS is an endocrine syndrome, hormones are majorly involved in diagnosis, symptoms and figuring out appropriate treatment.

The following is a breakdown of sine of the hormones that can be involved with PCOS.

LH/FSH 

LH (Lutenizing Hormone)

FSH (Follicle Stimulating Hormone)
The hormones that trigger ovulation

While many women with PCOS still have LH (Lutenizing Hormone) and FSH (Follicle Stimulating Hormone) within normal range, their LH level is often two or three times that of the FSH level.

This situation is called an elevated LH to FSH ratio or a ratio of 3:1. This change in the LH to FSH ratio is enough to disrupt ovulation. While this used to be considered an important aspect in diagnosing PCOS, it is now considered less useful in diagnosing PCOS, but is still helpful when looking at the overall picture.


Testosterone

All females assigned at birth have testosterone in their bodies. There are two methods to measure testosterone levels:

Total Testosterone
Free Testosterone

Total testosterone refers to the total amount of all testosterone, including the free testosterone, in your body. Free testosterone refers to the amount of testosterone that is active in your body. 

Patients with PCOS often have an increased level of both total testosterone and free testosterone. Even a slight increase in testosterone in a woman’s body can suppress normal menstruation and ovulation.


DHEA-S
DHEA-S or dehydroepiandrosterone is another male hormone that is found in all women. DHEA-S is an androgen that is secreted by the adrenal gland. It is normal for women to have DHEA-S levels anywhere between 35-430 ug/dl.  Most women with PCOS tend to have DHEA-S levels greater than 200 ug/dl.

DHEA sulfation is much more prevalent with #PCOS  2/3 of PCOS patients show increased DHEA/DHEAS ratio closely linked to total androgens.


Prolactin
Prolactin is a pituitary hormone that stimulates and sustains milk production in nursing mothers. Prolactin levels are usually normal in women with PCOS. However, it is important to check for high prolactin levels in order to rule out other problems, such as a pituitary tumor, that might be causing PCOS-related symptoms.  Some women with PCOS do have elevated prolactin levels

Androstenedione (ANDRO)
ANDRO is a hormone that is produced by the ovaries and adrenal glands. Sometimes high levels of this hormone can affect estrogen and testosterone levels.

Progesterone
Progesterone helps to prepare the uterine lining for pregnancy.  For women with PCOS, especially those who are trying to become pregnant using fertility medications, Progesterone levels are checked about 7 days after it is thought that ovulation occurred. 

If the Progesterone level is high, ovulation did indeed occur and the egg was released from the ovary.  If the progesterone level is low the egg was probably not released. This test is especially important because sometimes women with PCOS can have some signs that ovulation is occurring however, when the progesterone test is done, it shows that ovulation did not occur.

Estrogen
Estrogen is the female hormone that is secreted mainly by the ovaries and in small quantities by the adrenal glands.  The most active estrogen in the body is called estradiol. Estrogen is needed to work with progesterone to promote menstruation.

Most patients with PCOS are surprised to find that their estrogen levels fall within the normal range. However for some these levels are high when progesterone is deficient and can cause estrogen dominance.

TSH 
Thyroid Stimulating Hormone.

 is produced by the thyroid, a gland found in the neck. Women with PCOS usually have normal TSH levels.

TSH is checked to rule out other problems, such as an underactive or overactive thyroid, which often cause irregular or lack of periods and anovulation.

Anti-Mullerian Hormone(AMH)

is a hormone secreted by cells in developing egg sacs (follicles). The level of AMH in a woman's blood is generally a good indicator of her ovarian reserve.

AMH levels are typically higher in patients with PCOS and as such serves as a good marker of the syndrome and future fertility outcomes.


Insulin and Glucose
Due to the recent research that PCOS is probably caused by insulin resistance, physicians are beginning to check glucose levels as a factor when diagnosing PCOS. Thus is done eith a Fasting Plasma Glucose Test and a Glucose Tolerance Test at diagnosis and periodically thereafter, depending on risk factors. 
A high glucose level can indicate insulin resistance.

Cholesterol
Patients with PCOS have a greater tendency to have high cholesterol, a major risk factor for developing heart disease.   A high cholesterol level is considered greater than 200. Also, since the levels of good (high-density lipoproteins or HDL) and bad (low-density lipoproteins or LDL) are sometimes more indicative of a woman’s risk for developing heart disease, these levels might also be assessed.




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