PCOS Hormones:
Symptoms & Tests
Hormonal changes are an important part of PCOS. Understanding which hormones may be affected, what symptoms they can cause, and which tests may be useful can make your next step much clearer.
IN PCOS
PCOS does not mean that one hormone is simply “too high.”
PCOS involves changes in the way several hormones and body systems interact. These changes can influence ovulation, periods, skin, hair and metabolism. The exact pattern is different from one woman to another, which is why symptoms and test results can also vary.
Which hormonal changes matter in PCOS?
These are some of the key hormonal pathways doctors consider when assessing PCOS and its symptoms.
Androgens
Androgens are often called “male hormones,” but women naturally have them too. In some women with PCOS, androgen levels or their effects are higher than expected.
Insulin
Some women with PCOS have insulin resistance, meaning the body does not respond to insulin as effectively. The pancreas may then produce more insulin to keep blood glucose under control.
LH & FSH signalling
LH and FSH are hormones involved in communication between the brain and ovaries. In PCOS, this signalling can be altered, affecting follicle development and ovulation.
Progesterone
Progesterone normally rises after ovulation. When ovulation does not happen regularly, progesterone may not rise in its usual pattern.
Hormonal changes can show up in different ways
Your symptoms can provide important clues, but no single symptom tells the whole story.
Periods
Irregular, delayed or missed periods may reflect irregular ovulation.
Skin
Acne and oily skin may occur with androgen excess.
Hair
Increased facial hair or scalp hair thinning can be signs of androgen-related changes.
Ovulation
Ovulation may happen less often or at unpredictable times.
Which tests may be useful?
There is no single blood test that can explain every aspect of PCOS. Your doctor chooses tests according to your symptoms, menstrual pattern, examination and the possibility of other conditions that can look similar.
Total & Free Testosterone
These are important blood tests when assessing biochemical androgen excess. They can help determine whether androgen levels are higher than expected.
ANDROGEN ASSESSMENTDHEAS
DHEAS is an androgen produced mainly by the adrenal glands. Your doctor may consider it when testosterone does not explain the symptoms or when an adrenal source needs assessment.
WHEN APPROPRIATEProlactin
High prolactin can affect periods and ovulation. Testing may therefore be used to help exclude another cause of menstrual irregularity.
RULE OUT OTHER CAUSESTSH
Thyroid problems can cause changes in periods and ovulation. TSH may be checked when your doctor is assessing irregular menstrual cycles.
THYROID CHECK17-Hydroxyprogesterone
This test may be considered when another condition called non-classic congenital adrenal hyperplasia needs to be excluded as a cause of androgen excess.
SELECTED CASESProgesterone
If your doctor needs to confirm whether ovulation is occurring, progesterone can sometimes be measured at an appropriate time in the cycle.
OVULATION ASSESSMENTAMH
AMH reflects the number of small follicles in the ovaries and may have a role in PCOS assessment in adults. It should not be used as a single test to diagnose PCOS.
NOT A STANDALONE TESTHbA1c & Glucose Testing
PCOS can be associated with insulin resistance and increased metabolic risk. Your doctor may assess blood glucose using HbA1c, fasting glucose or an oral glucose tolerance test, depending on your situation.
METABOLIC ASSESSMENTYou do not need every hormone test.
It is easy to see a long list of hormone tests online and feel that you need to check everything. In reality, testing should be individualized.
A few important things to know about PCOS testing
Hormone tests can be helpful, but they are often misunderstood.
The ratio is not the diagnosis
LH and FSH may be measured in some situations, but an LH-to-FSH ratio should not be used by itself to diagnose PCOS.
Higher does not automatically mean PCOS
AMH can be useful in selected adults, but it is not a standalone PCOS test and should always be interpreted in context.
Very high levels need attention
Markedly high androgen levels or rapidly worsening symptoms may require further investigation for causes other than PCOS.
When should you talk to a doctor?
Consider medical evaluation if your periods are persistently irregular, you are developing significant acne or unwanted hair, your scalp hair is thinning, or you are having difficulty predicting ovulation or becoming pregnant.
Understanding your hormones is the beginning, not the end.
PCOS can look different from one woman to another. Once your symptoms and relevant tests are understood, treatment can be tailored to what matters most to you — whether that is regular periods, ovulation, fertility, skin and hair symptoms, or metabolic health.
Not sure which tests you need?
PCOS symptoms can overlap with other hormonal conditions. If you are unsure what your symptoms or test results mean, you can ask a qualified healthcare professional.
Ask a Doctor →Medical Content & Editorial Team, AuratSehat
Specialist Reviewer — Obstetrics & Gynaecology
This article was developed through AuratSehat’s medical content process and reviewed by a specialist in Obstetrics & Gynaecology for clinical accuracy and appropriateness.