What hormone levels are associated with polycystic ovary syndrome (PCOS)?
In PCOS, elevated male hormones, a disrupted LH-to-FSH ratio, and a reduced response to insulin are the most reliably established hormonal features. These are the values your GP or gynaecologist will measure first.
Elevated male hormones are the most characteristic hormonal sign of PCOS. Both testosterone and androstenedione are higher than normal in almost all women with PCOS, whether they are slim or not. This is one of the cornerstones of the diagnosis.
The ratio between LH (luteinising hormone) and FSH (follicle-stimulating hormone) is also disrupted: LH is too high, FSH relatively too low. This imbalance suppresses normal ovulation. How clearly this pattern shows up depends on your weight and where you are in your cycle.
Insulin also plays a central role. Women with PCOS are less responsive to insulin than women without PCOS, even at a comparable weight. Over time, this increases the risk of type 2 diabetes.
AMH (a hormone that reflects how active your ovaries are) is elevated in PCOS. A fixed cut-off value has not yet been established. In women with excess weight, AMH is actually lower, as are LH and progesterone, while male hormones tend to be higher at greater body weight. Excess weight therefore masks part of the typical pattern, making diagnosis more difficult.
For growth hormone and ghrelin there are indications of disruption in PCOS, but this has been described in limited research and its significance is still unclear. For TSH and prolactin, elevated levels were reported in one small study of 50 women, but that is not solid enough to draw firm conclusions from.
Finally, it matters which type of PCOS a person has. Women with both excess male hormones and absent ovulation have the most hormonal and metabolic abnormalities. Those who have PCOS without elevated male hormones generally have a milder profile.
This answer draws on several reviews and a combined analysis of 23 studies involving more than 4,500 women with PCOS. The findings on male hormones, the LH-to-follicle-stimulating hormone ratio, and insulin responsiveness are consistent and well documented. The findings on a hormone linked to egg reserve are moderately well supported: the combined analysis backs it up, but there is still no consensus on what level counts as too high. The findings on growth hormone and ghrelin come from one review; those on thyroid hormone and prolactin come from a single study of 50 women. The latter two rest on thin evidence.
Which hormone levels are characteristic of perimenopause and menopause?
Characteristic features are an early decline in AMH and inhibin B, followed by a rise in FSH and a late sharp fall in oestradiol. If you have symptoms, do not rely on a blood test alone, as hormone levels fluctuate considerably during the transition; discuss the pattern of your menstrual cycles and symptoms with your doctor.
What are normal hormone levels for women, and how do you get them tested?
There is no universal standard for hormone levels in women: they depend on age, cycle phase, and measurement method. Always have testing guided by a doctor who takes that context into account, especially for testosterone.
How do your hormone levels change throughout your menstrual cycle?
Your hormone levels follow a recognisable pattern throughout the cycle: oestrogen and progesterone rise and fall at set moments, with a sharp LH peak around ovulation. Bear in mind that there are large differences between women, and that the pill largely suppresses this pattern.
How do you get your hormone levels tested during perimenopause?
Hormone tests during perimenopause are difficult to interpret: AMH is the most practical option, but does not reliably predict your fertility. Always have results interpreted with the guidance of a doctor.
Which hormone levels are tested during menopause?
During menopause, the hormones measured most commonly are FSH, LH, oestradiol, progesterone, testosterone and AMH; elevated FSH combined with reduced oestradiol (below 20 pg/ml) is the most reliable sign that menopause has begun, but always have your results explained by your doctor, as body weight and background influence reference values.
What role do hormones play in mental health complaints?
Hormones, and cortisol in particular, play a demonstrable role in mental health complaints in a proportion of patients, but psychiatry cannot simply use this as a universal explanation. Have your hormone levels measured if you suspect that stress or hormonal dysregulation is contributing to your complaints, and discuss this specifically with your doctor.