All Conditions
Women's Health

PCOD / PCOS: Understanding Your Hormone Tests

Polycystic Ovary Syndrome (PCOS) affects an estimated 8–13% of women of reproductive age worldwide. Here's what the blood tests used to diagnose and manage it actually measure: and what your results mean.1

Written by Suman Konda, Clinical Pharmacist · Based on peer-reviewed sources · Editorial policy · Not medical advice

Last reviewed and updated: · How we check our content

What PCOD/PCOS is

Advertisement

Polycystic ovary syndrome (PCOS) is a hormonal disorder in which the ovaries produce excess androgens (male hormones), causing irregular periods, excess facial or body hair (hirsutism), acne, hair thinning and difficulty conceiving. PCOD (polycystic ovarian disease) is the older term, often used interchangeably.

PCOS affects an estimated 8–13% of women of reproductive age worldwide. It is also strongly linked to insulin resistance, weight gain and a higher long-term risk of type 2 diabetes and heart disease — so evaluation covers metabolism as well as hormones.1

How PCOD is usually evaluated

Diagnosis needs at least two of the three Rotterdam criteria — no single test suffices:

CriterionWhat counts
Oligo- or anovulationInfrequent or absent ovulation, causing irregular or absent periods
HyperandrogenismClinical (acne, hirsutism) or biochemical (elevated testosterone or DHEAS)
Polycystic ovaries on ultrasound12 or more follicles of 2–9 mm in at least one ovary, or ovarian volume above 10 mL

The ultrasound finding alone does not make the diagnosis: 20–30% of reproductively aged women have “polycystic-looking” ovaries without the syndrome. It is the combination with irregular cycles or androgen excess that counts. Blood tests support the picture: LH:FSH ratio above 2:1 (supportive, not diagnostic), total testosterone elevated (severely elevated testosterone above 5 nmol/L suggests a tumour and warrants imaging, not PCOS treatment), AMH 2–3 times higher than normal, fasting insulin and HbA1c for insulin resistance — with TSH and prolactin checked to rule out thyroid disease and other causes, and 17-hydroxyprogesterone to exclude congenital adrenal hyperplasia.23

Your next steps if PCOD is suspected

  1. Confirm it is the combination, not the scan alone. Ask whether you meet two of the three Rotterdam criteria — irregular cycles or androgen excess plus the ultrasound — and what has been done to exclude other causes.
  2. Get metabolic screening, not just hormone tests. Because insulin resistance runs alongside PCOS so often, fasting insulin and HbA1c matter as much as the androgen panel.
  3. Discuss fertility plans openly if relevant. Ask whether a pelvic ultrasound to count follicles is needed and how PCOS may be affecting fertility.
  4. Ask which lifestyle changes move the needle most. Weight management is among the most effective measures for restoring ovulation and lowering metabolic risk — ask what is realistic for you.
  5. Track the androgen signs over time. Hirsutism, acne and hair thinning respond slowly; knowing what to monitor helps judge whether the plan is working.

Practical notes

Hormone levels fluctuate through the menstrual cycle, so trends matter more than any single reading. Keep a simple cycle log — start dates, flow, missed periods — for several months, and note symptoms such as acne or hair changes alongside the dates. When blood tests are repeated, comparing results drawn at a similar cycle phase is more meaningful than comparing random-day values, so keep the cycle day written on each report.

A few details make hormone results much easier to interpret: every medicine and supplement you take (including contraceptive pills, which alter hormone levels), your weight history, any family history of diabetes or thyroid disease, whether you fasted before glucose or insulin tests, and the cycle day the blood was drawn. Bringing this list to the appointment lets your doctor spend the visit on interpretation rather than detective work.

The lifestyle factors most often discussed in PCOS care are gradual, sustainable weight management — even modest weight change can improve ovulation and metabolic markers in some people — regular physical activity, balanced meals, adequate sleep, and not smoking. These are discussed as long-term health measures alongside medical treatment, not as alternatives to it, and what helps varies from person to person.

Follow-up testing in PCOS is usually spaced out: hormone panels are not repeated every cycle, and ultrasound is repeated only if there is a clinical reason. Metabolic markers such as HbA1c, fasting glucose and lipids are typically rechecked about once a year, since long-term follow-up in PCOS focuses as much on diabetes and cardiovascular risk as on cycles — ask your doctor what your personal review schedule should be.

In India

A pelvic ultrasound typically costs ₹800–₹2,000, individual hormone tests (LH, FSH, prolactin, testosterone, thyroid) a few hundred rupees each, and HbA1c around ₹300–₹600 — so a full PCOS workup commonly runs into a few thousand rupees, though prices vary by city and lab.

Look for NABL-accredited laboratories and imaging centres, which follow standardised quality processes. In major cities, most large labs offer home sample collection for the blood tests; ultrasound scans are done at a diagnostic centre. Whatever a lab's website says about normal values, the reference range printed on your own report is the one that counts, since ranges differ between machines and assay methods.

Frequently asked questions

What is the difference between PCOD and PCOS?

PCOD (polycystic ovarian disease) is the older term; PCOS (polycystic ovary syndrome) is the current one. They are often used interchangeably, though technically the syndrome framing better captures that it is a hormonal and metabolic condition, not just an ovarian one.

What does a high LH:FSH ratio mean in PCOS?

Normally LH and FSH are roughly equal (1:1). In PCOS, LH is persistently elevated relative to FSH, disrupting the normal ovulation cycle. A ratio above 2:1 is a classic finding, but it is supportive of PCOS — not diagnostic on its own — and is less reliable if taken during the mid-cycle LH surge.

What does high AMH mean?

AMH (anti-Müllerian hormone) is produced by ovarian follicles. In PCOS the multiple small follicles make AMH 2–3 times higher than normal. High AMH alongside irregular periods and androgen excess strongly supports PCOS, and many centres now use it as a more reliable marker than the LH:FSH ratio.

How is PCOS diagnosed: the Rotterdam criteria?

PCOS is diagnosed when at least two of three Rotterdam criteria are met: irregular or absent ovulation, clinical or biochemical signs of androgen excess (acne, hirsutism, elevated testosterone), and polycystic ovaries on ultrasound. Other causes of androgen excess — thyroid disease, Cushing’s syndrome, congenital adrenal hyperplasia (measured by 17-OHP) — must be excluded.1

Is PCOS linked to diabetes?

Yes, strongly. PCOS is closely linked to insulin resistance and weight gain, with a higher long-term risk of type 2 diabetes and heart disease. Fasting insulin and HbA1c are commonly checked, and weight management is one of the most effective ways to improve ovulation and metabolic risk.2

My ultrasound shows polycystic ovaries but my periods are regular — do I have PCOS?
Not necessarily. Polycystic-looking ovaries on ultrasound are common and can occur without PCOS; the Rotterdam criteria require at least two of three features — irregular ovulation, signs of androgen excess, and polycystic ovaries — with other causes excluded. Only your doctor, looking at symptoms, blood tests and scan together, can say whether the label fits.
Can I do the hormone blood test on any day of my cycle?
Some tests are timing-sensitive: LH and FSH are often drawn on cycle days 2–5, while glucose and insulin usually need an overnight fast. Your doctor's prescription should specify the timing — if it doesn't, ask the lab or your doctor before going, since a mistimed sample may need repeating.
Will losing weight cure my PCOS?
Weight management can improve symptoms — more regular ovulation, better insulin sensitivity — in people who are above a healthy weight, but it is not a cure and it does not work the same for everyone, including lean PCOS. Think of it as one part of long-term management to discuss with your doctor, not a one-time fix.
Should my sister get tested now that I have PCOS?
PCOS does run in families, but testing without symptoms is not usually recommended. If your sister has irregular periods, persistent acne, excess hair growth or difficulty conceiving, those would be reasons to discuss evaluation with a doctor — a diagnosis is made on clinical features, not on family history alone.

References

Sources cited on this page. PubMed links open the original abstract.

  1. Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod. 2018;33(9):1602–1618. PMID 30052961 · doi:10.1093/humrep/dey256
  2. Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447–2469. PMID 37580314 · doi:10.1210/clinem/dgad463
  3. Teede HJ, Tay CT, Laven JJE, et al. 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Eur J Endocrinol. 2023;189(2):G43–G64. PMID 37580861 · doi:10.1093/ejendo/lvad096
Medical Disclaimer: This page is for general educational purposes only and does not constitute medical advice. Always consult a qualified doctor before making any health decisions.
Written and medically reviewed by Suman Konda, Clinical Pharmacist · Sources linked to PubMed · Not medical advice: see our disclaimer