Hormones in PCOS

Many women have reached out to ask me to explain what their hormones look like if they have PCOS and this is a great follow up after looking at “normal cycles” and hormones for those on “the pill”.

PCOS is a hormonal disorder which is commonly diagnosed in young women. It was named for multiple cysts seen on the ovaries of patients diagnosed with PCOS, although this is a bit of a misnomer as patients with PCOS will not always have cystic ovaries.

Symptoms of PCOS

• Irregular periods or absence of your period
• Unusual or unwanted hair growth, for example hair growth on the chin or head hair loss
• Acne
• High blood sugar
• High blood pressure
• Weight gain or the inability to lose weight
• Inability to get pregnant
• Fatigue
• Sleep problems

Hormones

Unlike the last two posts, it is much harder to provide a diagram of what hormones will look like in a cycle. This is because PCOS can present differently in various patients. Some people may have a 2-month cycle, some may not ovulate, and some may cycle regularly.

There are multiple female hormones that PCOS will affect like androgens, estrogen, and progesterone.

Androgens:

All females normally produce small amounts of androgens, like testosterone. In PCOS patients these androgens are usually greatly elevated.

Progesterone:

Progesterone levels are often decreased in PCOS.

LH and FSH:

LH and FSH are also hormones involved in a women’s menstrual cycle. In a “normal” female the ratio of LH to FSH is 1:1 (except right before ovulation) but in PCOS this ratio will often be abnormal.

How is PCOS diagnosed?

Currently, the most widely accepted way is by using something called the Rotterdam criteria:

Two of three are needed to make the diagnosis:

• Oligo – and/or anovulation – which means irregular cycles, or you are not ovulating.
• Clinical and/or biochemical signs of hyperandrogenism – which means signs of high testosterone like acne or unwanted hair growth (like on the chin) OR high androgen on your labs work.
• Polycystic ovaries (by ultrasound) – exactly like it sounds, cysts are seen on your ovaries when imaging is performed.