Approximately 5-10% of women in their childbearing years are affected by polycystic ovarian syndrome (PCOS). It is one of the leading causes of infertility, and it significantly raises the risk of cardiovascular disease and other chronic conditions. However, many integrative and functional medicine therapies can be effective in the treatment of PCOS. In order to create the proper treatment plan, proper testing and interpretation must be done. This article will discuss the functional medicine labs that should be monitored on a bi-annual basis for patients with PCOS. 

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What is Polycystic Ovary Syndrome (PCOS)?

PCOS is a chronic disorder in women with reproductive hormone irregularities. In order to be diagnosed with PCOS, a woman must have two of the three following symptoms: high androgens (DHEA, testosterone) in blood testing or signs of elevated androgens such as facial hair or dark body hairs (hirsutism); ovarian growths found on an ultrasound that look like cysts; irregular or lack of periods.

Symptoms of PCOS include greasy skin, thinning hair or bald spots, weight gain, hirsutism, infertility, cycle irregularities, heavy periods, and dark, velvety spots on the skin (acanthosis nigricans).

The exact cause of PCOS is unknown. However, high androgens, insulin resistance, inflammation, and genetics seem to play a role in its development. 

Women with PCOS are at a greater risk for infertility, heart disease, type 2 diabetes, obesity, obstructive sleep apnea, mood disorders, autoimmune thyroid conditions, non-alcoholic fatty liver disease (NAFLD), chronic kidney disease, and metabolic syndrome. 

Importance Of Regular Lab Testing For PCOS Patients

Lab testing is essential in women with PCOS as hormones fluctuate and may differ from month to month. Additionally, treatment plans with effective therapies can cause significant changes in hormone patterns. Thus, it's important to regularly monitor labs in women with PCOS, so proper adjustments can be implemented, including starting or stopping supplements and/or adjusting dosages.  

Top Labs to Run Bi-Annually on Your Patients Who Suffer From Polycystic Ovary Syndrome (PCOS)

Since PCOS can affect many different organ systems, there are many labs and markers that should be checked on a bi-annual basis to ensure the proper treatment plan is in place. 

Hormone Panel

There are many different options for hormone testing in functional medicine. One of the most popular tests is the DUTCH test by Precision Analytical. The DUTCH is a dried urine test that assesses hormone metabolites or breakdown products. This is an excellent choice for women with PCOS, as the DUTCH shows not only estrogen metabolism but also androgen metabolism, which is often high in those with PCOS.

‍Androgen metabolism starts with DHEA and ends with breakdown products of testosterone, one of which is dihydrotestosterone (DHT) and is more potent than testosterone itself. DHT may be high with low or normal testosterone levels, so if only looking at testosterone levels, you may be missing one of the most critical pieces in your patient's PCOS etiology.

Additionally, the DUTCH test estrogen metabolism section is also crucial for those with PCOS. In PCOS, what has been mistakenly called ovarian cysts are actually immature ovarian follicles. These follicles can exist due to improper levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in the brain. When this occurs, and multiple immature follicles are present, they may all be making estrogen which can lead to excessive estrogen levels. This is why it's important to analyze estrogen metabolism.

There are three phases to estrogen metabolism, two of which occur in the liver and are shown on the DUTCH test. If a woman with PCOS who has high estrogen isn’t metabolizing estrogen properly, this can lead to a backup of estrogen in the body and even higher estrogen levels. The DUTCH test will report reference ranges on the test to help the practitioner and patient know if they are within range. 

FSH and LH Testing

FSH and LH levels should also be monitored in women with PCOS. FSH and LH, released from the pituitary gland, orchestrate the entire menstrual cycle; they tell the ovary what to do and when to do it. FSH and LH are often offered on a panel together, as with the FSH and LH test from Access Medical Laboratories. The levels of these hormones will vary depending on the day of the menstrual cycle, and thus practitioners will need to advise patients on how to properly track and count the days in their cycle: day 1 of the cycle is the first day of their period.

FSH Reference Range 

‍FSH is usually measured between days 2-5 of the cycle.

FSH: 5-20 mIU/L

LH Reference Range

LH is usually measured mid cycle to assess if ovulation will, or did, occur. ‍

LH Mid Cycle Peak: 0.61 to 16.3 IU/mL

Prolactin and Sex Hormone-Binding Globulin (SHBG) Testing

Additionally, hormones that may be important for women with PCOS include prolactin and sex hormone-binding globulin (SHBG). Prolactin, as offered as a stand-alone test by Access Medical Laboratories, is a hormone released by the pituitary gland and should only be elevated in breastfeeding women, as it causes milk production in the breasts. However, around 30% of women with PCOS have elevated prolactin levels, which in turn can affect estrogen and progesterone levels. It’s important to know that elevated prolactin levels always warrant further investigation, as pituitary tumors can cause elevated prolactin and thus need to be ruled out.

SHBG is the transporter for certain sex hormones, including testosterone, in the body. When a hormone is bound to SHBG, it is inactive. In women with PCOS, SHBG is often low. SHBG, as offered by ZRT Laboratories, is also usually provided as a stand-alone marker.

Prolactin Reference Ranges 

Nonpregnant women: <25 ng/mL

SHBG Reference Ranges 

For females <50 years old: 19-145 nmol/L

For females >50 years old: 14-136 nmol/L

Comprehensive Thyroid Panel

Lastly, thyroid hormones should be monitored in women with PCOS, as PCOS women are more likely to develop subclinical hypothyroidism and autoimmune thyroid conditions. Thus, a thyroid panel, such as the test offered by Boston Heart Diagnostics, including thyroid hormones TSH, total and free levels of T4 and T3, and antibodies (anti-TPO and TG), should be done. 

Blood Sugar Panel

Markers surrounding blood sugar physiology must be checked in women with PCOS. Blood sugar, or glucose, is transported in the body by insulin, a hormone made in the pancreas. Insulin should deliver glucose to cells throughout the body, where glucose will be converted into energy. However, a process called insulin resistance can occur, where cells stop accepting insulin, resulting in higher levels of glucose in the blood.

Insulin resistance is a problem for anyone as it increases the risk of heart disease and diabetes, especially in women with PCOS, as insulin will trigger androgen production in the ovaries worsening PCOS symptoms. To fully assess blood sugar physiology, glucose, insulin, and hemoglobin A1c are optimal.

Hemoglobin A1c is the average glucose level over the previous six weeks. Additionally, certain labs offer a HOMA-IR score, such as the Boston Heart Diagnostics HOMA-IR test, which calculates insulin resistance based on glucose and insulin levels. 

Fasting Glucose Reference Ranges 

Normal: A fasting blood sugar level of less than 100 mg/dL (5.6 mmol/L). 

Prediabetes: A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L).

Diabetes: 126 mg/dL (7 mmol/L) or higher on two separate tests.

Fasting Insulin Reference Ranges 

Normal: 2.6-24.9 mcIU/ml; however, from a functional perspective, a level of 7mcIU/ml is considered to be high. 

Hemoglobin A1C (Hba1c) Reference Ranges 

Prediabetes: Hba1c level between 5.7% and 6.4% 

Diabetes: Hba1c level at 6.5% or above

Cholesterol Panel 

As PCOS increases the risk of cardiovascular disease, it's a good idea to monitor and track cholesterol (lipid) levels. An advanced lipid panel, such as BostonHeart Diagnostics Comprehensive Lipid Panel, goes beyond a traditional lipid panel by showing various markers, including apoproteins, that give more detail on the risk of cardiovascular disease.

Inflammatory Panel 

Chronic, low-grade inflammation is often present in women with PCOS and can contribute to higher androgen levels. Additionally, inflammation is linked to various diseases that PCOS women are already at a higher risk for, including cardiovascular disease and diabetes. Thus, monitoring inflammation levels is warranted. Lab markers to evaluate inflammation include hsCRP, ESR, and homocysteine. 

Micronutrient Levels

There is evidence that women with PCOS are often deficient in many micronutrients, including various B vitamins, selenium, zinc, chromium, and vitamins D, K, and E. Thus, a micronutrient test that includes all of the micronutrients mentioned above may be wise to evaluate and monitor. V

Liver and Kidney Function Tests 

Liver and kidney function tests should also be monitored in women with PCOS. For liver function, enzymes, including AST and ALT, should be routinely evaluated as these markers can let the practitioner know if a liver pathology is beginning, such as non-alcoholic fatty liver disease (NAFLD), of which women with PCOS may have four times greater risk of developing. Kidney markers, including BUN, GFR, and creatinine, will allow the practitioner to assess kidney function, which is vital since there is a relationship between PCOS and the development of chronic kidney disease. A comprehensive metabolic panel (CMP), such as the CMP offered by Access Medical Laboratories, will include all of these important kidney and liver markers. 

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Summary

Polycystic ovarian syndrome is a chronic condition affecting many women. The symptoms of PCOS are vast and significant, including baldness or hair loss, acne, mood changes, irregular periods, infertility, and more. Functional medicine offers many effective therapies that can help to manage and reduce the symptoms of PCOS. However, there are many therapy options, and deciphering which option is appropriate for which patient can be difficult. This is where functional medicine testing becomes incredibly important. Testing results can help guide the practitioner to formulate a personalized and effective treatment plan. Bi-annual testing allows the treatment plan to follow the patient’s changing physiological state, which in turn leads to continuous symptom relief and a higher quality of life.