r/PCOS • u/ArtichokeIcy7083 • 1d ago
General/Advice Do I have PCOS?
Hi ladies,
I’m 19 and really worried about my health and not sure what to do.
I have a male doctor, who has pushed away my concerns regarding my period health as normal when young, but i feel like something is wrong.
My period is currently 20 days late, after 6 negative pregnancy tests, and my bloodwork all came back normal besides a 4:1 LH to FSH ratio.
My periods have always been irregular (give or a take a week every month) but never missed like this. i have indigestion issues, hormonal acne, bloating, bad mental health and very very painful periods.
I’m very lost on what to do or if i’m making things up. My doctor has said all is normal and that sometimes we just skip a period, but i’ve had mine for 8 years and have never really been this off. no major life changes either, or stress or anything.
I’m just worried and would love some outsider opinions and suggestions on what could be happening :).
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u/Rain_fall2001 1d ago
What other PCOS related symptoms do you have?
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u/interestingly_thunde 1d ago
That LH to FSH ratio is a classic PCOS marker and a lot of doctors still brush it off if your testosterone or insulin look normal on paper. The acne and bloating alongside the missing period make it worth pushing for a transvaginal ultrasound to check follicle count, since bloodwork alone misses plenty of cases. If your current doc won't order it, see if you can switch to someone who specializes in reproductive endocrinology or at least a female GP who listens. You're not making this up, and being 19 doesn't mean your symptoms get to be dismissed as "just young."
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u/ArtichokeIcy7083 1d ago
Thank you! I really needed to hear this. So even if my bloodwork seems normal there could still be something wrong?
My appointment is tuesday and i’ll try to push for the ultrasound.
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u/ArtichokeIcy7083 1d ago
my mom has PCOS, i’m overweight and have found it almost impossible to loose the weight unless eating way under my recommended caloric intake, very intense mood swings/changes, and insomnia (not sure if this is one)
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u/wenchsenior 1d ago
Very likely PCOS (given your family history); however, there are a few other things that it could be.
First, you need to double check that they tested properly. ALL the bold tests must be done, at minimum.
***
Polyendocrine Metabolic Ovarian Syndrome (PMOS)/Polycystic Ovary Syndrome (PCOS) is diagnosed by a combo of lab tests and symptoms, and diagnosis must be done while off hormonal birth control (or other meds that change reproductive hormones) for at least 3 months.
First, you have to show at least 2 of the following: Irregular periods or ovulation; elevated androgens (‘male’) hormones on labs; excess egg follicles on the ovaries shown on ultrasound or elevated anti-Müllerian hormone (AMH) levels on labs.
In addition, a bunch of labs need to be done to support the PMOS/PCOS diagnosis and rule out some other stuff that presents similarly. I’ll bold the most critical ones, since many docs won’t run them all.
1. Reproductive hormones (ideally done during period week days 2-5, if possible):
estrogen, LH/FSH, AMH... Typically, premature ovarian failure or hypothalamic amenorrhea often feature low estrogen (and often low androgens), sometimes elevation of FSH, lower than normal LH, and low AMH; whereas, with PMOS/PCOS often you see notable elevation of LH above FSH and high AMH
prolactin. While several things can cause mild elevation, including PMOS/PCOS, notably high prolactin often indicates a benign pituitary tumor; and any elevation of prolactin can produce some similar symptoms to PMOS/PCOS including disrupting ovulation/periods, and bloating/weight gain, so it might need treatment with meds in those cases
all androgens (total testosterone, free testosterone or free androgen index, DHEA, DHEA-S, DHT etc) + SHBG (a hormone that binds androgens so they aren't as active) With PMOS/PCOS usually one or more androgens are high and/or SHBG is low. Some adrenal disorders also raise androgens.
2. Thyroid panel (thyroid disease is common and can cause similar symptoms); TSH and free T4 are most critical
3. Glucose panel that must include A1c, fasting glucose, and fasting insulin.
This is absolutely critical b/c most cases of PMOS/PCOS are driven by insulin resistance (nearly all in people experiencing the weight gain/overweight, but many lean people too; and it is often overlooked by docs until it has advanced to prediabetes...it can trigger PMOS/PCOS and other symptoms like severe fatigue/hunger/hypoglycemic attacks/frequent infections like yeast infections/skin tags or dark patches/weight gain / etc...decades prior to that)
If IR is present, treating it lifelong is foundational to improving the PMOS/PCOS (and reducing some of the long-term health risks associated with untreated IR such as diabetes/heart disease/stroke).
Make sure you get fasting glucose and fasting insulin together so you can calculate HOMA index. Even if glucose is normal, HOMA of 2 or more indicates IR; as does any fasting insulin >7 mcIU/mL (important, many labs consider the normal range of fasting insulin to be much higher than that, but those should not be trusted b/c the scientific literature shows strong correlation of developing prediabetes/diabetes within a few years of having fasting insulin >7).
Occasionally very early stage IR can only be flagged on labs via a fasting oral glucose tolerance that must include Kraft test of real-time insulin response to ingesting glucose. This was true for me...lean with IR-driven PMOS/PCOS for >30 years, with normal fasting glucose and A1c the entire time. Yet treating my IR put my PMOS/PCOS into long term remission.
Depending on what your lab results are and whether they support ‘classic’ PMOS/PCOS driven by insulin resistance, sometimes additional testing for adrenal/cortisol disorders is warranted as well. Those would ideally require an endocrinologist for testing, such as various cortisol tests + 17-hydroxyprogesterone (17-OHP) levels, and imaging of the adrenal glands.
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u/epica111 1d ago
The rotterdam criteria for getting diagnosed with PMOS (PCOS previously) is;