PCOS Hormone 101 for
Getting Pregnant Naturally
Irregular periods and difficulty conceiving are indicators that you need to get your hormones tested. Hormone testing can be a tricky business as they fluctuate constantly. In this article, you will learn how to properly investigate your hormones to discover the root cause of your period and fertility problems.
Hormones are the chemical language of your body. They are how your body communicates with itself about safety, needs, emotions and so much more. Each hormone takes its cues from the others, so even the smallest imbalance can create a domino effect of havoc.
But before this reality causes more stress and raises your cortisol, the stress hormone, let me assure you, we can significantly improve your hormone imbalances in 3 steps!
Test to Discover ~ Determine the Cause ~ Treat to Balance
Testing and uncovering the imbalances is what we will talk about in this post so let’s dive in!
“If my hormones get anymore out of control the next hurricane will be named after me.”
Irregular cycles often indicate anovulatory cycles, basically, you aren’t ovulating. If you aren’t ovulating then you won’t be able to get pregnant. Don’t panic just yet though because this is not uncommon and there are many treatment options available to restore ovulation.
The most common cause of female infertility is Polycystic Ovarian Syndrome, PCOS, which affects at least one out of every ten women.
If you are concerned that you may have PCOS, or perhaps your doctor thinks you might, based on your signs and symptoms:
- Menstrual irregularities
- Absent period (amenorrhea)
- Heavy menstrual flow (menorrhagia)
- Abnormal mid-cycle bleeding
- Anovulatory cycles (when the ovary doesn’t release an egg)
- Recurrent miscarriage
- Weight gain or obesity (despite healthy eating and active lifestyle)
- Acne (especially back and chest)
- Hirsutism (excessive body hair)
- Hair loss
- History of ovarian cysts
- Estrogen excess symptoms like PMS and fibrocystic breast disease
Then the next step is to get your hormones checked! This step is where a lot of confusion comes in, and not just for you! Evaluating hormones with blood work is not straightforward and even many medical practitioners struggle with this part of the PCOS workup in order to get a proper diagnosis.
The criteria for being diagnosed with PCOS is:
You must have at least two of the following three symptoms
- Irregular cycles or anovulatory cycles
- Signs of elevated androgens/abnormal
- Cystic ovaries
Once we know both your hormone levels and your symptoms then we can visualize the root cause of your PCOS, hormone imbalance, and infertility so that we can dig into the fertility repair.
I have worked with too many women who have only had a partial work up or haven’t had blood work done at all.
Reasons for skipping a proper workup range from unsure when to test because you don’t have a cycle, or because symptoms seem to make the diagnosis obvious making a comprehensive workup “irrelevant”, or because the well-meaning practitioner just isn’t up to date on the best PCOS testing.
To be clear the guidelines are fuzzy at best and the treatments your doctor will likely recommend are not dependent on the full list of labs that I will discuss below. The reason I recommend a full hormone workup is as follows.
First, this is your starting point. Sure without a period, or with an irregular cycle it may be difficult to know when to test and you may not get the most accurate information but you will establish a baseline.
Second, your hormone levels assist in determining your root cause of PCOS. Each person is unique in their hormone profile and why they are struggling to regain and repair their fertility.
By establishing a baseline picture you can take the proper steps to repair your fertility, and then retest, and monitor your hormones as needed to track your progress.
The tricky part is getting accurate hormone levels and knowing when to test. I go into this in more detail inside the PCOS Rx Workshop, where I walk you through when to test but also how to interpret your lab values. You will also get a flow chart of the most important hormones and how they relate to the root cause of your PCOS.
Here is a comprehensive list of what you should test and why when you think or have been told you have PCOS.
The PCOS Rx: 5 Steps to Your Fertility Repair
Allow me to walk you through the 5 steps to repair your fertility. In these 5 steps, you will learn how PCOS is affecting your ability to get pregnant, how to get a proper workup so that you have a clear understanding of your hormone imbalance, and create your dream team of practitioners to help you finally repair your fertility on your journey to becoming a mommy.
Luteinizing hormone (LH): Follicle Stimulating Hormone is used to assess infertility problems or irregular menstrual cycles or to diagnose disorders of the pituitary gland or diseases involving the ovaries
Follicle-stimulating hormone (FSH): Luteinizing hormone – it is produced by the pituitary gland. It increases suddenly at ovulation (LH surge) causing the release of an egg from the ovaries.
Free Testosterone: Is more reliable than total testosterone and gives more information about various conditions, including PCOS. PCOS may be suspected in elevated testosterone
Sex hormone-binding globulin (SHBG): SHBG controls the amount of testosterone that your body can use, and it varies with age.
Dehydroepiandrosterone-sulfate (DHEA-S): An androgen produced only by the adrenals DHEA-S (as opposed to testing just total DHEA) shows the amount of DHEA available in the body
Estrogen (estradiol): Estradiol is a form of estrogen that is tested with blood work. Levels that are either too high or too low could indicate PCOS.
Cortisol: Cortisol is a steroid hormone released by the adrenal glands when your body perceives stress. Cortisol can be tested with a blood test
Fasting Glucose: Glucose levels are most commonly measured to diagnose diabetes. This level can be within normal limits, however, you still have insulin resistance or you’re on the verge of developing insulin resistance.
Fasting Insulin: This is a better test than fasting glucose to determine possible insulin resistance. However, even if you are starting to drift towards insulin resistance, the lab level may still be considered normal
Hemoglobin A1C: similar to a fasting glucose this lab value evaluates your blood sugar, in this case with a rolling average approach which I find more useful
Fasting Lipid Panel: PCOS increases your risk of heart disease
Vitamins and nutrient levels: including Vitamin D, B12, Zinc, Magnesium
CMP: This test gives a glimpse into your basic health including liver, kidneys nutrition,
CBC: Tests the health of your blood cells. This is less related to PCOS but if you haven’t had blood done in a while is a good thing to include when running labs.
Ferritin: checks your iron levels Some women with PCOS experience heavy bleeding during their period. This can result in iron deficiency anemia.
Androstenedione: An androgen produced by both the ovaries and the adrenals.
17-OHP: 17- Hydroxyprogesterone (also called 17-OH Progesterone).It is a steroid hormone and testing is used to diagnose congenital adrenal hyperplasia (and classical and non- classical). The ACTH stimulation test usually accompanies 17-OHP test if the results are abnormal. Further testing should be discussed with a doctor.
Prolactin: A hormone the increases naturally when you are pregnant as your body prepares to breastfeed. This used to rule out other health concerns besides PCOS. High prolactin does not mean you have PCOS. It is a health issue of its own, and the causes should be investigated!
Thyroid: A full thyroid panel (including the Free T3, Free T4, and TPO) is the best way to assess the thyroid function. Testing only TSH can leave mild conditions and even Hashimoto’s disease undiagnosed.
THS: The first test in evaluating the thyroid but I recommend a full thyroid panel at least once
Free T3: This is the active thyroid hormone created from the conversion of thyroxine into triiodothyronine. It comes in 3 forms: total, free, and reverse. Free T3 is not bound to protein and considered the active form of triiodothyronine.
Free T4: Is the unbound T4 in the blood, too much or too little could indicate a thyroid disorder.
TPOAb (Thyroid Peroxidase antibodies): Thyroid antibodies are used to diagnose autoimmune disorders including Hashimoto’s
To learn when to have each test performed for reliable information and what to with the information from your hormone tests join the PCOS Rx workshop!
Ashlene Korcek PA-C
Hi there! I’m Ashlene Korcek, the PCOS Mama and founder of Nourished to Healthy
I help women with Polycystic Ovarian Syndrome balance their hormones naturally so that they can take back control of their bodies, boost their fertility, and ultimately live free from the symptoms of PCOS. Like you, I have PCOS, I was diagnosed while struggling with infertility and was told I likely would never have children. Even as a board-certified Physician Assistant I felt lost about what to do and very alone! Fast forward 5 years and I have 3 healthy children, but I never want another woman to feel lost and alone the way I did!
You can break free from the downward spiral of PCOS and feel amazing in your own skin again!