This month we are talking about PCOS and hormones in my private Facebook community: head over to the group and search #PCOSPower to find all our posts! The group can be found here: https://www.facebook.com/groups/LBBMedicine/
Many women in my practice tell me that they were diagnosed with PCOS just from an ultrasound showing cysts, but they had no other symptoms and no blood work was done.
Other women tell me that despite having all the symptoms and the blood work, they were told they don't have PCOS or any hormone issues.
In my opinion, both situations are very confusing. I believe that both ultrasounds and blood or saliva testing for hormones is extremely important to fully diagnose and manage a patient with hormone concerns.
Always request lab work when you have hormone concerns. Many times high estrogen has the same symptoms as low progesterone, and most people focus on lowering estrogen and never raise progesterone. Some overdose on progesterone because it's sold in a bottle from a store and they were told it's a miracle cure. Some have no idea that they can actually raise or lower their testosterone naturally. I have seen many women who have been diagnosed with PCOS with low testosterone.
The difference in testing is that blood tests look at inactive or protein bound hormones and saliva looks at free or active hormones. The tests will often look different if there is an issue, typically you look great with blood work but your saliva test shows something is low or high.
My preference is a traditional baseline blood panel with a saliva test for hormones.
With blood you want to look at glucose, hemoglobin A1c, iron and ferritin, a full thyroid panel (TSH, total T4, rT3, T3 uptake, and TPO). You can also request an Anti-Müllerian Hormone screen.
With saliva testing the test includes all three types of estrogen, progesterone, and testosterone. The adrenal stress index will test DHEA, melatonin, and cortisol. There are a few options: test one day, test over 3 days, or test over the whole cycle. Depending on your cycle, your age, and symptoms we can pick the right test for you.