From the Research
Repeating PCOS labs is necessary when a patient with known PCOS experiences new or worsening symptoms like amenorrhea and hair loss, as it helps to distinguish between worsening PCOS and other conditions that may present with similar symptoms. The most recent and highest quality study, 1, published in 2021, highlights the importance of clinical and biochemical markers in differentiating between functional hypothalamic amenorrhoea and polycystic ovarian syndrome.
Key Considerations
- The workup should include hormonal tests such as testosterone, DHEAS, androstenedione, thyroid function tests (TSH, free T4), prolactin levels, and possibly a comprehensive metabolic panel to assess liver function and glucose metabolism.
- For amenorrhea specifically, measuring FSH, LH, and estradiol can help determine if ovarian function has changed, as noted in 2 and 1.
- Additionally, checking ferritin and complete blood count may be useful to rule out anemia as a cause of hair loss.
- The study 1 found that BMI, estradiol, LH, and LH:FSH ratio had the greatest predictive performance for differentiating between functional hypothalamic amenorrhoea and PCOS.
Diagnostic Approach
- A thorough clinical evaluation, including medical history and physical examination, is essential in assessing the patient's symptoms and determining the need for further testing.
- The use of clinical and biochemical markers, as identified in 1, can help differentiate between PCOS and other conditions that may present with similar symptoms.
- Early identification of the cause of new or worsening symptoms allows for appropriate treatment adjustments, whether that involves modifying PCOS management or addressing a new condition, as emphasized in 3 and 4.