PCOS
PCOS is a hormonal imbalance in which your ovaries make too many male hormones. You often notice it as irregular or absent periods, acne or excess hair. Insulin plays a large part, and the chance of type 2 diabetes is higher. About 6% of women have PCOS. In full it is called polycystic ovary syndrome.
What are the symptoms of PCOS?
How strong is the evidence?
- strong
- In the Dutch guideline, or confirmed in several controlled trials.
- fair
- From one controlled trial, an international guideline or a review of research.
- limited
- The research does not point one way.
Evidence as of October 2026. New research can shift this.
These complaints are also described with iron deficiency.
PCOS can go unnoticed for a long time. Excess weight adds to the suspicion, but PCOS also occurs with a normal build, and the period is usually infrequent rather than gone altogether. Without skin complaints and without attention to the cycle it then often only stands out when wanting a child. The sugar and fat side is silent for years too.
None of these complaints belongs to PCOS alone, and a measurement explains no complaint: the reading and the diagnosis belong with your GP. The complaint list follows the Dutch GP guideline on amenorrhoea (NHG).
When is your LH too high?
Normal for women (follicular):
2.4 to 10.9 U/L
Enter your value as it appears on your results. Range for adults.
No value yet? How to get it measured
What do you do about PCOS?
Losing weight, even 5%
Exercise and not smoking
The pill or a hormonal IUD
Inducing ovulation
Having the lining of the womb checked
Have your blood sugar measured
Follows the Dutch GP guideline on amenorrhoea (NHG) and the international PCOS guideline.
What causes PCOS?
Hormonal
Hormonal
Insulin
Insulin
Weight and predisposition
Weight and predisposition
- Excess weight, which adds to the suspicion and strengthens the insulin side
- PCOS also occurs at a normal build
How to get PCOS measured
Every value below has its own page: what is normal, and what your value means.
| Value | What it shows | Points here when |
|---|---|---|
| LHdefining | Raised in PCOS, while FSH stays normal. Only assessable in the first days of the cycle. | high |
And 11 values that complete the picture
| Value | What it shows | Points here when |
|---|---|---|
| Total testosterone | Raised in most women with PCOS. Only readable beside SHBG, and the upper limit differs from 1.7 to 2.6 nmol/L per lab. | high |
| SHBG | Falls with a high insulin, so more testosterone circulates free. Rises on the pill, which distorts the total. | low |
| FAI (free androgen index) | Total testosterone divided by SHBG: the working share in one number. | high |
| Free testosterone | The same question, calculated from total, SHBG and albumin. | high |
| FSH | Normal in PCOS. Strongly raised points instead to a premature menopause, the picture next door. | abnormal |
| Prolactin | A high prolactin also disturbs the cycle. Belongs in the panel to exclude that other cause. | abnormal |
| Oestradiol | Stays continuously present in anovulation without progesterone; low in a premature menopause. | abnormal |
| Fasting glucose | The sugar side: PCOS goes with insulin resistance as in type 2 diabetes. | high |
| HbA1c | The three-month average, for the same question. | high |
| Triglycerides | Rises when the liver sees too much insulin; often the earliest trace. | high |
| HDL Cholesterol | Falls in the same pattern. | low |
- The comprehensive test (€229, single test) measures the values on this page.
- Every draw is fasted: nothing to eat or drink from midnight, only water. Appointments are therefore in the morning, until 12:00.The day of the cycle counts: LH, FSH and oestradiol belong in the first days of the cycle, progesterone in the second half, and that takes two draws.
- You can draw at 600+ locations near you, no referral needed. See the locations
- Results within 24 hours of analysis, in the app.
What is PCOS?
In a normal cycle one follicle matures under the influence of FSH, releases ever more oestradiol, and a peak of LH sets ovulation going. In PCOS that maturation stalls: the ovaries contain many small follicles in development, but none becomes dominant, probably under the influence of androgens, LH and insulin. Women with PCOS therefore have a raised LH with a normal FSH, and most a raised testosterone and other androgens such as DHEA. Insulin plays a role of its own in that. PCOS is linked to insulin resistance, as in type 2 diabetes, and a high insulin lowers SHBG, the protein that binds testosterone. More free testosterone then circulates, and insulin also stimulates the production of androgens in ovaries and adrenal glands. That is why a PCOS picture is read from two sides, the hormones and the sugar and fat balance beside them, and why a healthy lifestyle belongs with the approach. Whether losing weight also restores the cycle has not been convincingly shown: there are indications, but the research is weak. The exact cause is unknown, disposition plays a part, and PCOS also occurs with a normal build. The diagnosis asks for at least 2 of 3 features: an absent or infrequent period, signs of too many androgens in skin or blood, and polycystic ovaries on ultrasound. In the long term PCOS carries a higher chance of type 2 diabetes, also at a normal weight, and that is why blood sugar is measured every 1 to 3 years. Whether the chance of cardiovascular disease is higher too is less certain: the international guideline assumes it, the Dutch GP guideline calls it unclear.
What is PCOS confused with?
Each with the one value that tells the two apart.
Premature menopause
Also absent periods, but with a strongly raised FSH and a low oestradiol: the NHG speaks of a premature menopause at FSH above 40 IU/L with oestradiol below 100 pmol/L. In PCOS, FSH is normal.
Hyperprolactinaemia
A high prolactin, from medication or a prolactinoma, also suppresses the cycle. Prolactin itself decides.
Androgen-producing tumour
Hirsutism that arises in a short time, with other signs of virilisation and a strongly raised testosterone. Rare, but the reason the NHG watches the pace of the complaints.
Also cycle disturbances and weight gain, through a different hormone. TSH keeps the two apart.
Frequently asked questions
By an irregular, infrequent or absent period, and by signs of too many androgens: excess hair in a male pattern, acne and hair loss on the head. Excess weight adds to the suspicion, but PCOS also occurs with a normal build, and the sugar and fat side you do not feel. The diagnosis asks for at least 2 of 3 features, with polycystic ovaries on ultrasound as the third.
Sources 3
- 1.NHG-Standaard Amenorroe. 2018. richtlijnen.nhg.org
- 2.Teede HJ et al., Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome, Journal of Clinical Endocrinology & Metabolism. 2023. doi.org
- 3.Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome, Human Reproduction. 2004. doi.org
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This page explains what a result means. It is not a diagnosis and not treatment advice. Discuss complaints or an abnormal value with your doctor.
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