PCOS Frequently Asked Questions (& Answers!) – Part II

For PCOS Awareness Month in September, I did Part I of this series. I answered a lot of food questions in relation to PCOS. In this post, I’m answering a bit of a mish-mash of PCOS questions I answer on the regular.

Can I have PCOS without polycystic ovaries?

Yup! According to the Rotterdam criteria, you need a minimum of 2 out of 3 of the following to meet a PCOS diagnosis (given that those symptoms aren’t because of another condition):

  1. Oligo- or anovulation. This refers to infrequent ovulation or a lack of ovulation.
  2. Clinical and/or biochemical signs of hyperandrogenism. This means that we are either seeing elevated androgen levels (DHEA-s and testosterone) in blood work and/or we’re seeing manifestations of high androgens in the form of hirsutism, alopecia, and/or acne.
  3. Polycystic ovaries.

What blood work is important for people with PCOS? 

The answer to this question is a bit of a long-winded one. The only blood work that is helpful in diagnosing PCOS is the androgens (testosterone, DHEA, androstenedione, for e.g.).

However, since PCOS is a complex condition with different components, blood work should also include your routine parameters like CBC, ferritin (iron), vitamin B12, vitamin D, cholesterol panel, HbA1c, glucose, liver enzymes, thyroid panel, kidney function tests, and electrolytes.

Since vitamin D deficiency, thyroid disorders, insulin resistance, thyroid disorders, and inflammation are associated with PCOS, those tests should be run to understand your health. What that looks like is vitamin D testing (not covered under OHIP in Ontario), fasting insulin + glucose to calculate your insulin resistance score (HOMA-IR), full thyroid panel with TSH, T3, T4, anti-TPO antibody, anti-TG antibody, and inflammatory marker like CRP.

If there’s anything else going on your health as an individual, then we layer in other tests.

NDs in Ontario can run blood work (it’s just not covered under OHIP) and I run tests in my office a lot (especially those that might’ve been missed by other docs).

What is insulin resistance?

I’m going to direct you to my insulin resistance blog post which explains the concept and offers a few lifestyle considerations for it. It’s important to remember that a high percentage of PCOS is driven by insulin resistance, which has a genetic component.

I have non-alcoholic fatty liver disease as well. How did that happen and what do I do?

NAFLD is prevalent in those with PCOS, especially when insulin resistance is present as well. This concept is explained in a previous blog post with some suggestions and food for thought.


That’s it for Part II. I’ll write up a part III in the new year! Stay tuned!




Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2004. Fertil Steril 81: 19-25.