From the Guidelines
Monitoring PCOS requires essential laboratory tests, including reproductive hormones (testosterone, free testosterone, DHEAS, androstenedione, LH, FSH, estradiol, and SHBG), metabolic parameters (fasting glucose, HbA1c, fasting insulin, and lipid panel), thyroid function tests (TSH, free T4), and prolactin levels, as recommended by the most recent study 1. These tests help diagnose PCOS and monitor treatment effectiveness. Key points to consider when monitoring PCOS include:
- Reproductive hormones:
- Testosterone
- Free testosterone
- DHEAS
- Androstenedione
- LH
- FSH
- Estradiol
- SHBG
- Metabolic parameters:
- Fasting glucose
- HbA1c
- Fasting insulin
- Lipid panel (including total cholesterol, LDL, HDL, and triglycerides)
- Thyroid function tests:
- TSH
- Free T4
- Prolactin levels For patients with irregular periods, progesterone levels during the luteal phase can assess ovulation, as noted in 1. Patients on metformin should have vitamin B12 levels checked annually, while those on spironolactone need electrolyte monitoring, as part of comprehensive management 1. Regular screening for insulin resistance is important as PCOS patients have a higher risk for type 2 diabetes, highlighting the need for ongoing metabolic monitoring 1. Frequency of testing varies based on treatment and symptoms, but annual metabolic screening is generally recommended, with more frequent monitoring for those on medications or with abnormal results, as emphasized in the most recent guidelines 1. These tests collectively help manage PCOS effectively by addressing both reproductive and metabolic aspects of the condition.
From the Research
Labs to Monitor in PCOS
To monitor PCOS, several labs can be useful in assessing the risk of associated complications such as metabolic syndrome, type 2 diabetes, and cardiovascular disease. These include:
- Fasting plasma glucose test 2, 3
- Oral glucose tolerance test (OGTT) 2, 4, 3, 5
- Insulin levels, including fasting insulin 5, 6
- Glycosylated hemoglobin (HbA1c) levels 2
- Glucose/insulin (G:I) ratios, particularly the fasting G:I ratio 5
- Lipid profile, given the association with cardiovascular risk 4
- Hormonal assessments, such as LH:FSH ratio and androgen levels, which can be relevant for hyperandrogenism and reproductive abnormalities 6
Rationale for Each Lab
- Fasting Plasma Glucose and OGTT: These tests are crucial for assessing glucose metabolism and identifying insulin resistance or impaired glucose tolerance, which are common in PCOS patients 2, 3.
- Insulin Levels: Elevated fasting insulin levels are associated with insulin resistance and can be a marker for the risk of developing type 2 diabetes and cardiovascular disease in PCOS patients 5, 6.
- Glycosylated Hemoglobin (HbA1c): This test provides an average of blood glucose levels over the past 2-3 months and can be useful in monitoring long-term glucose control in PCOS patients, although its use as a screening tool for diabetes in PCOS is still under debate 2.
- Glucose/Insulin (G:I) Ratios: The fasting G:I ratio has been proposed as a simple and effective screening tool for insulin resistance in PCOS patients, with a ratio of less than 4.5 indicating insulin resistance 5.
- Lipid Profile and Hormonal Assessments: These are important for evaluating the risk of cardiovascular disease and managing hyperandrogenism and reproductive issues associated with PCOS 4, 6.