The Meaning of PCOS Lab Results

At least 10% of women of childbearing ages have polycystic ovary syndrome (PCOS), an endocrine disorder that has both reproductive and metabolic consequences. Women with PCOS tend to have higher levels of insulin and, as a result, are at an increased risk for metabolic conditions such as dyslipidemia (high triglycerides and low HDL levels), type 2 diabetes, and metabolic syndrome. Over half of women with PCOS are overweight or obese, and many report struggles to lose weight despite a healthy diet and exercise regimen.

Yet, despite their difficulties with weight loss, patients with PCOS are often told to lose weight and their PCOS will get better. While weight loss may improve menstrual regularity and reduce the risk of metabolic conditions, it doesn’t mean PCOS will go away. Sometimes focusing on weight loss takes the focus off the importance of health. Meaning, women with PCOS can make sustainable changes to their diet and lifestyle to optimize their health and improve their lab values. This can occur with or without weight loss.

Below is a list of common blood tests that are frequently done to monitor PCOS. Other lab results and criteria may be used to diagnose a woman with PCOS. To keep PCOS from getting worse and to reduce the risk of long-term chronic conditions, women with PCOS should aim to keep these blood tests within normal ranges. To stay on top of your health, keep track of your blood results and compare changes with each new test.

Insulin

While insulin is not part of the diagnostic criteria for PCOS, it is sometimes checked to monitor PCOS and to see how insulin resistant someone is. Ideal levels of fasting insulin should be under 10 mg/dL. High levels of insulin are a risk factor for type 2 diabetes. A fasting insulin test is very sensitive and is most accurate when done with a controlled research study. Outside of a study, a fasting insulin test is most reliable when performed along with an oral glucose tolerance test, which is more accurate and specific.

C-Reactive Protein

Compared to women without PCOS, women with the condition show higher levels of the inflammatory marker c-reactive protein (CRP). CRP measures inflammation in the body. An elevated CRP is associated with an increased risk for coronary artery disease (CAD) in some individuals. High-sensitive CRP (hs-CRP) is more accurately used. Levels of hs-CRP below one are considered low, levels of one to three are considered moderately elevated, and levels greater than three are considered high.

Triglycerides

Triglycerides (TG) are the blood storage form of fat. Ideal fasting levels of TG should be under 150 mg/dL. High levels indicate an increased risk for cardiovascular disease. TG can become elevated due to diets high in carbohydrates, inactivity, obesity, and high insulin levels (often the case in PCOS). Besides a healthy diet and lifestyle, TG can be reduced with fish oil supplementation.

HDL

HDL, or “good," cholesterol, removes excess cholesterol in the blood and can help to protect you against heart disease. Studies have shown that low HDL levels are a risk factor for developing cardiovascular disease. Normal HDL cholesterol levels range between 40 and 60 mg/dL. Low HDL levels are common in women with PCOS. Low levels of this cholesterol can be caused by inactivity, genetics, stress, smoking, high triglycerides, and a poor diet.

Hemoglobin A1C

The hemoglobin A1C test, also commonly referred to as A1C, is a measure of your blood sugar control over the past two to three months. This test is used to diagnose pre-diabetes or diabetes and to see if changes to your lifestyle, diet, and medications or nutritional supplements are reducing your risk for diabetes. An HA1C level of 7% or higher is an indicator of diabetes. To be classified as having pre-diabetes, an HA1C level is typically between 5.7% and 7%.

Liver Enzymes

Liver function tests, or “LFTs”, are the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) which become elevated when the liver is damaged. These can be used to diagnose and monitor non-alcoholic fatty liver disease (NAFLD). NAFLD occurs in 15%to 55% of women with PCOS, depending on the diagnostic criteria used. NAFLD occurs as a result of excess triglycerides (fat) stored in the liver which causes damage and inflammation. The good news is that fatty liver can be reversed with lifestyle modifications. Changes to your diet, activity, and specific dietary supplements can improve fatty liver disease.

AMH

Anti-Mullerian Hormone (AMH), is a special protein released by cells that are involved with the growth of an egg follicle each month. AMH levels correlate with the number of antral follicles found on the ovary each month; the higher the antral follicle count, the higher the AMH levels. Because women with PCOS typically have high numbers of antral follicles, high AMH levels are often seen as well. AMH is also used as an indicator of ovarian reserve in older women.

Normal AMH levels range between 0.7 ng/mL to 3.5 ng/mL. Levels below 0.3 ng/mL are considered low and indicate that lower numbers of eggs are within the ovary and decreased fertility. Levels above 5.0 ng/mL are high and can indicate PCOS.

Vitamin D

An inverse relationship exists in women with PCOS who have low vitamin D levels and an increased risk of metabolic health issues. Assessing or vitamin D status is important for good health and well-being. The Endocrine Society recommends levels be at least 30 ng/mL, although some other organizations, such as The Vitamin D Council, suggest vitamin D levels should be around 40 ng/mL.

Vitamin B12

If you take metformin, you should be having your vitamin B12 levels checked annually as metformin can affect the absorption of this crucial vitamin. Optimal ranges of vitamin B12 should be 450 pg/mL or higher. Other blood tests that can detect B12 status include homocysteine and methylmalonic acid. Supplementation with vitamin B12 is now recommended if you take metformin.