Laboratory Tests FSH (Follicle Stimulating Hormone), will be normal or low with PCOS LH (Lutenizing Hormone), will be elevated LH/FSH ratio. This ratio is normally about 1:1 in mensturating women, but with PCOS a ratio of greater than 2:1 or 3:1 may be considered diagnostic Testosterone, total and/or free, usually elevated DHEAS (may be done to rule out a virilizing adrenal tumor in women with rapidly advancing hirsutism), frequently mildly elevated with PCOS Estrogens, may be normal or elevated, reversal of E1:E2 ratio Sex hormone binding globulin, may be reduced Androstenedione, may be elevated Lipid profile (low HDL, high LDL, and cholesterol, elevated triglycerides) Glucose, fasting and/or a glucose tolerance test, may be elevated Insulin, often elevated Fasting Glucose: fasting insulin ratio < 4.5 Non-Laboratory Tests With PCOS, the ovaries may be 1.5 to 3 times larger than normal and characteristically have more than 12 follicles per ovary, with each follicle less than 10 mm (2-9 mm) in diameter. Ovarian volume is usually > 10 cc. Often the cysts are lined just under the surface the ovaries, forming the appearance of a "pearl necklace." These ultrasound findings are not diagnostic as they are present in more than 90% of women with PCOS, but they are also found in up to 15-25% of women without PCOS. Hyperinsulinemia can present as a cluster syndrome called metabolic syndrome or dysmetabolic syndrome X. This is a risk factor for cardiovascular disease The presence of three of the following five criteria confirm the diagnosis of metabolic syndrome, and an insulin lowering agent and/or other interventions may be warranted Metabolic Syndrome Diagnostic Criteria Female waist >35 inches Triglycerides >150 mg/dL HDL <50 mg/dL Blood pressure >130/85 mmHg Fasting glucose: 110-126 mg/dL Two-hour glucose (75 gm OGTT): 140-199 mg/dL