Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder among women of reproductive age. It can have a significant impact on a woman’s menstrual cycle, fertility, and overall health. Diagnosing PCOS accurately is crucial as it allows for appropriate management and treatment. A combination of different tests is usually required to confirm the presence of PCOS, as the syndrome is characterized by a set of symptoms and hormonal imbalances rather than a single definitive marker. These tests help healthcare providers evaluate the various aspects of the condition, including ovarian function, hormonal levels, and metabolic health.
Ovarian Function Tests
Transvaginal Ultrasound: This is a key test for assessing ovarian morphology. The ultrasound probe is inserted into the vagina to obtain detailed images of the ovaries. In PCOS, the ovaries may appear enlarged and have multiple small cysts, usually around 2 to 9 mm in diameter, arranged in a characteristic “string of pearls” pattern. The procedure is relatively quick and minimally invasive. It helps to visualize the structure of the ovaries and detect any abnormal growths or cysts. The cost of a transvaginal ultrasound can vary but is generally around $200 to $500, depending on the location and facility.
Ovulation Monitoring
Basal Body Temperature (BBT) Charting: Women can track their basal body temperature daily using a special thermometer. In PCOS, ovulation may be irregular or absent. By charting BBT, a woman can observe if there is a consistent rise in temperature after ovulation. However, this method has limitations as it may not accurately predict ovulation in cases of PCOS due to hormonal fluctuations. The thermometer for BBT charting usually costs between $10 and $50.
Ovulation Predictor Kits (OPKs): These kits detect the surge in luteinizing hormone (LH) that precedes ovulation. In PCOS, the LH to follicle-stimulating hormone (FSH) ratio is often elevated. OPKs can help determine if there is an LH surge, but again, the results may be unreliable in some PCOS cases. The cost of a pack of OPKs is around $20 to $50.
Hormonal Tests
Blood Tests for Hormone Levels
Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH): Measuring the levels of these hormones is essential. In PCOS, the LH to FSH ratio is typically higher than normal, often greater than 2:1. For example, a normal LH level might be around 5 to 20 mIU/mL, and a normal FSH level around 4 to 10 mIU/mL. However, in PCOS, the LH level may be elevated, sometimes above 10 mIU/mL, while the FSH level remains relatively normal. The cost of testing both LH and FSH is around $50 to $150.
Testosterone: Elevated levels of testosterone are common in PCOS. This can lead to symptoms such as hirsutism (excessive hair growth) and acne. The normal range of total testosterone in women is around 20 to 80 ng/dL. In PCOS, it may be above this range. Testing for testosterone costs approximately $50 to $100.
Androstenedione: This is a precursor to testosterone. Levels of androstenedione are often increased in PCOS. It is measured in the blood, and the normal range is around 0.5 to 3.5 ng/mL. Abnormal levels can further support the diagnosis of PCOS. The cost of this test is around $50 to $100.
Prolactin: Although not always elevated, checking prolactin levels is important as it can affect ovulation. High prolactin levels can suppress the hypothalamic-pituitary-ovarian axis. The normal range of prolactin in non-pregnant women is around 2 to 29 ng/mL. The test for prolactin costs about $50 to $100.
Metabolic Tests
Glucose Tolerance Test: Women with PCOS are at an increased risk of developing insulin resistance and glucose intolerance. A glucose tolerance test involves fasting overnight and then drinking a glucose solution. Blood samples are taken at specific intervals to measure the body’s ability to process glucose. If the body has difficulty regulating blood sugar levels, it may indicate insulin resistance. The cost of a glucose tolerance test is around $100 to $300.
Insulin Level Testing: Measuring fasting insulin levels and sometimes postprandial (after a meal) insulin levels can help assess insulin resistance. High insulin levels can contribute to the development of PCOS symptoms and increase the risk of type 2 diabetes and cardiovascular disease. The cost of testing insulin levels is around $50 to $150.
Lipid Profile: PCOS can also affect lipid metabolism. A lipid profile test measures levels of cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Abnormal lipid levels can increase the risk of heart disease. The cost of a lipid profile is around $50 to $100.
Other Tests
Thyroid Function Tests: Thyroid disorders can mimic some symptoms of PCOS or coexist with it. Tests for thyroid-stimulating hormone (TSH), free thyroxine (T4), and sometimes thyroid antibodies are done. Abnormal thyroid function can affect menstrual regularity and fertility. The cost of a comprehensive thyroid function test is around $100 to $200.
17-Hydroxyprogesterone: This test is used to rule out congenital adrenal hyperplasia (CAH), which can have similar symptoms to PCOS. The normal range of 17-hydroxyprogesterone is around 0.2 to 2.2 ng/mL. The test costs around $50 to $100.
