Biomarkers

Add us on Google

How to Test for PMOS (PCOS): Blood Tests, Hormone Panel, Diagnosis and What Results Mean

PCOS, now called PMOS, is diagnosed from two of three features after other causes are ruled out. Here are the blood tests involved, from testosterone, SHBG and AMH to glucose and lipids, and what each result means.

Published

February 9, 2026

Last updated

October 21, 2026

Read time

15 min read

Medically reviewed by

Rhonda Collins, FNP-C

Share

Copy link

Summarize with AI

Polycystic ovary syndrome (PCOS), now called Polyendocrine Metabolic Ovarian Syndrome (PMOS), is diagnosed when an adult has at least two of three features: irregular or absent ovulation, high androgens (on symptoms or a blood test), and polycystic ovaries on ultrasound or a high AMH level. Other conditions that look similar must be ruled out first. No single blood test confirms PCOS on its own.

The blood tests involved fall into three groups. Androgen tests (total testosterone, free testosterone or the free androgen index, and sometimes DHEA-S) check for excess male-type hormones. Exclusion tests (TSH, prolactin, 17-hydroxyprogesterone and FSH) rule out conditions that mimic PCOS. Metabolic tests (a glucose test and a lipid profile) are recommended for everyone at diagnosis, because PCOS raises the risk of type 2 diabetes. An AMH test can stand in for the ultrasound in adults.

The new name was published in The Lancet on May 12, 2026, after a global consensus process. Both names are in use during a transition that runs to 2028, so this guide uses both. PCOS affects an estimated 10% to 13% of women of reproductive age, and the World Health Organization estimates that up to 70% of those affected do not know they have it.

In this guide, you’ll learn:

• How PCOS (PMOS) is diagnosed, step by step
• Which blood tests are in a PCOS hormone panel, and why
• What blood test results for PCOS typically show
• How to time and prepare for testing
• Answers to common questions, such as which hormone is high in PCOS

How Is PCOS (PMOS) Diagnosed?

The 2023 International Evidence-based Guideline for PCOS, which builds on the 2003 Rotterdam criteria, diagnoses PCOS in adults when two of these three features are present:

1. Ovulatory dysfunction: irregular or absent periods. For adults, the guideline defines irregular cycles as shorter than 21 days, longer than 35 days, or fewer than 8 cycles a year.
2. Hyperandrogenism: clinical signs such as excess facial or body hair (hirsutism), or biochemical signs, meaning raised testosterone or free testosterone on a blood test.
3. Polycystic ovarian morphology: 20 or more follicles in at least one ovary on ultrasound, or, in adults only, a raised AMH level instead of the ultrasound.

Other causes of these features must be excluded before the diagnosis is made. That is why a PCOS workup always includes tests for thyroid, prolactin and adrenal conditions.

Two details matter for testing:

• If you have both irregular cycles and high androgens, you already meet the criteria. The guideline says neither an ultrasound nor an AMH test is needed in that case.
• Teenagers are diagnosed differently. Adolescents need both irregular cycles and high androgens. Ultrasound and AMH are not recommended for diagnosis in this age group.

Why Blood Tests Matter for PCOS

PCOS affects more than reproductive hormones. It is linked to a higher risk of impaired glucose tolerance, type 2 diabetes and unfavorable cholesterol levels, regardless of age or weight. The guideline describes it as a condition with reproductive, metabolic, cardiovascular and psychological features.

Blood tests do four jobs in a PCOS workup:

• Confirm biochemical hyperandrogenism, which may not be obvious on a physical exam
• Rule out thyroid, pituitary and adrenal conditions that mimic PCOS
• Check glucose and cholesterol, which the guideline recommends for everyone at diagnosis
• Set a baseline to compare against over time

Core Hormone Panel for PCOS

A hormone panel for PCOS focuses on the androgen and reproductive hormones that are often altered in this condition. The key markers are below.

1. Total Testosterone, SHBG and the Free Androgen Index

Raised androgens are the most common lab finding in PCOS. The guideline recommends measuring total testosterone and free testosterone to assess biochemical hyperandrogenism. Free testosterone, the active portion not bound to protein, can be estimated with the free androgen index (FAI).

The FAI is a calculation, not a separate blood draw. It divides total testosterone by sex hormone-binding globulin (SHBG), the protein that carries testosterone in the blood, and multiplies by 100. A higher FAI means more testosterone is free to act on tissues.

SHBG is often low in PCOS, and low SHBG is closely linked to insulin resistance. When SHBG is low, more testosterone circulates free, so total testosterone can look normal while the FAI is high. That is why testosterone is best read alongside SHBG. Mito’s Free Androgen Index (FAI) test measures total testosterone and SHBG and reports the calculated FAI.

High androgens are linked to acne, excess hair growth and scalp hair thinning. The guideline notes that a blood test adds the most value when those clinical signs are mild or absent. It also notes that androgen levels well above the lab’s range call for checking other causes, such as adrenal or ovarian tumours and congenital adrenal hyperplasia.

2. DHEA-S and Androstenedione

DHEA-S comes almost entirely from the adrenal glands, and androstenedione comes from both the adrenals and the ovaries. The guideline suggests measuring them when testosterone and free testosterone are not elevated, noting that both are less specific for PCOS and that DHEA-S falls with age. High DHEA-S levels can also point toward an adrenal source of excess androgen.

Read more: SHBG vs DHEA-S: Understanding Health Markers

3. AMH (Anti-Müllerian Hormone)

AMH is made by the small follicles in the ovaries. Because PCOS ovaries hold more of these follicles, AMH is often higher. The 2023 guideline is the first to accept a raised AMH as an alternative to ultrasound for the polycystic ovary criterion, with clear limits:

• Adults only. AMH should not yet be used for diagnosis in adolescents.
• Never on its own. AMH is not a single test for PCOS. It counts only as one of the three criteria, alongside cycle and androgen findings.
• Either AMH or ultrasound, not both, to avoid over-diagnosis.
• Not needed if irregular cycles and high androgens are already present.

AMH results depend on context. In the general population, AMH peaks between ages 20 and 25, is lower at a higher BMI, can be suppressed by current or recent use of the combined pill, and can vary across the menstrual cycle. Labs should use cut-offs specific to their assay and population, so there is no single universal “PCOS” AMH number. Mito offers a standalone AMH blood test.

Read more: Normal AMH Levels by Age

4. LH and FSH

Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) regulate ovulation. In many women with PCOS, LH is higher relative to FSH. The LH-to-FSH ratio is not a diagnostic criterion, but it can support other findings. FSH also has an exclusion role: together with LH, it helps rule out low hormone output from the pituitary, which can follow low body fat or intensive exercise.

Read more: LH vs FSH: Understanding Health Markers

5. Estradiol and Progesterone

Estradiol shows estrogen activity and is usually normal or mildly raised in PCOS. Progesterone rises after ovulation, so the guideline notes that a serum progesterone level can confirm whether ovulation happened when that needs checking. Together they add context to irregular cycles.

Metabolic Blood Tests for PCOS

The guideline recommends two metabolic checks for everyone diagnosed with PCOS, regardless of age or BMI: glycaemic status and a lipid profile. Insulin resistance is common in PCOS even at a healthy weight.

1. Glucose Testing: OGTT, Fasting Glucose or HbA1c

The guideline recommends assessing glycaemic status at diagnosis and every one to three years after that, depending on other diabetes risk factors.

• 75-gram oral glucose tolerance test (OGTT): the guideline’s first choice, regardless of BMI. You fast, drink a glucose solution, and have blood drawn again two hours later.
• Fasting glucose and/or HbA1c: options when an OGTT can’t be done. The guideline notes these are significantly less accurate in PCOS.

HbA1c reflects your average blood glucose over the past two to three months.

Read more: Fasting Glucose vs HbA1c

2. Lipid Profile

The guideline recommends a lipid profile at diagnosis for everyone with PCOS: total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. How often to repeat it depends on the result and on other cardiovascular risk factors.

3. Fasting Insulin: A Mechanism Marker, Not the Screen

Fasting insulin shows the mechanism behind many PCOS features. Insulin resistance pushes insulin up, high insulin is linked to lower SHBG, and lower SHBG leaves more testosterone free. A high fasting insulin can appear before glucose rises.

Fasting insulin is not the guideline’s screening test, though. The 2023 guideline calls insulin resistance a key driver of PCOS but says clinically available insulin assays are of limited clinical relevance and are not recommended in routine care. The recommended screens are the glucose tests and lipid profile above. Fasting insulin can add context when you want to see the mechanism, but a normal result does not replace a glucose test.

Exclusion Tests: Ruling Out Conditions That Mimic PCOS

PCOS is only diagnosed after other causes are excluded. The guideline’s diagnostic algorithm names these tests:

1. TSH (Thyroid)

TSH screens for thyroid disease, which can cause irregular periods and weight changes. A normal result helps confirm that the symptoms are not thyroid-related.

2. Prolactin

High prolactin can disrupt ovulation. This test excludes pituitary causes of irregular cycles.

3. 17-Hydroxyprogesterone

This test rules out non-classical congenital adrenal hyperplasia, an inherited adrenal condition that can raise androgens and look like PCOS.

4. FSH

FSH helps exclude primary ovarian insufficiency and, with LH, pituitary causes of absent periods. The guideline adds that other causes, such as Cushing’s syndrome or adrenal tumours, are checked when the clinical picture suggests them.

What Blood Test Results for PCOS Typically Show

Why Normal Results Don’t Always Rule Out PCOS

Normal hormone results don’t always mean you don’t have PCOS. You can meet the criteria with irregular cycles plus clinical signs such as hirsutism, or plus polycystic ovaries on ultrasound, even when testosterone is in range. The guideline treats hirsutism alone as a strong predictor of biochemical hyperandrogenism in adults.

Results can also shift with:

• Cycle timing
• Recent weight changes
• Hormonal medications, especially the combined pill, which raises SHBG and lowers androgen production
• The assay used, since reference ranges vary widely between labs and methods

A diagnosis rests on the overall pattern of cycle history, symptoms, blood tests and, where used, ultrasound or AMH, not on one lab value.

When to Schedule PCOS Blood Tests

Timing matters for accurate interpretation.

• Early-cycle testing: LH, FSH and estradiol are usually measured on days 2 to 5 of the menstrual cycle. If your cycles are irregular or absent, testing at a consistent time is a common approach.
• Progesterone: measured in the second half of the cycle, about a week before an expected period, to check whether you ovulated.
• Fasting tests: glucose, insulin and lipid panels usually need an 8 to 12 hour fast. An OGTT also starts fasted.
• AMH and androgens: less tied to cycle day, but still affected by the combined pill.

How to Prepare for a PCOS Blood Test

A few steps help your results reflect your usual hormone levels:

• Follow any fasting instructions for glucose, insulin and lipid tests.
• List any supplements or medications you take, including hormonal contraception, when you order or book your test.
• Avoid intense exercise the day before your draw.
• Know that the combined pill makes androgen results hard to read. The guideline says that if androgen testing is essential, the pill should be stopped for at least three months first, with other contraception used in the meantime. Talk with a clinician before changing any prescribed medication.

Blood Tests vs Ultrasound in PCOS Diagnosis

Blood tests and ultrasound answer different questions. Blood tests measure androgens, exclude other conditions and check metabolic health. Ultrasound looks at ovarian structure, counting follicles.

Since 2023, AMH can replace ultrasound for the ovary criterion in adults, so many adults can be assessed without a scan. If you already have irregular cycles and high androgens, neither is needed. Some women have polycystic-appearing ovaries without other features, and that finding alone does not mean PCOS.

What Happens After a PCOS Diagnosis?

There is no single cure for PCOS, but symptoms and long-term risks can be managed. Care depends on your goals: regulating cycles, managing hair growth or acne, supporting fertility, or addressing metabolic risk. It usually combines lifestyle support, medication where appropriate and ongoing monitoring.

Monitoring continues after diagnosis. The guideline recommends rechecking glycaemic status every one to three years, with the lipid profile repeated based on your results and risk factors.

Getting Tested for PCOS With Mito

You can order the blood tests in a PCOS workup through Mito, at a partner lab or, for some tests, with an at-home kit. Choose by what you need to answer:

• Androgen check: the Free Androgen Index (FAI) test measures total testosterone and SHBG and calculates the FAI.
• Polycystic ovary criterion in adults: the AMH test.
• Broader hormone picture from home: the At-Home Women’s Hormone Test Kit covers LH, FSH, estradiol, progesterone, prolactin, Free T4, DHEA-S and total testosterone. It does not include SHBG, so add the FAI test if you want a free androgen estimate.
• Hormones and metabolic markers together: the Mito Core Panel (women’s version) includes LH, FSH, estradiol, total and free testosterone, SHBG, DHEA-S, TSH, prolactin, glucose, HbA1c, insulin and a lipid panel.

Every Mito result is reviewed by a clinician before your analysis is finalized. Note that an OGTT and a pelvic ultrasound are done in person, and a diagnosis of PCOS is made in a clinical assessment that brings your history and results together.

Frequently Asked Questions

• What are the three markers of PCOS? The three diagnostic features are irregular or absent ovulation, high androgens (clinical signs or raised testosterone on a blood test), and polycystic ovaries on ultrasound or, in adults, a raised AMH. Two of the three are needed, after other causes are excluded.

• Which hormone is high in PCOS? Androgens, mainly testosterone. Free testosterone or the free androgen index is often high, and SHBG is often low. AMH is frequently raised, LH is often high relative to FSH, and insulin is often elevated because of insulin resistance.

• What vitamin am I lacking if I have PCOS? There is no single vitamin deficiency that defines PCOS. Vitamin D is the most studied: lower levels have been reported in many studies, but a 2026 meta-analysis of 11 studies found no difference in vitamin D between non-obese women with PCOS and controls, suggesting weight rather than PCOS may drive low levels. If you take metformin, the guideline notes it may be associated with low vitamin B12. A vitamin D or vitamin B12 test shows your own levels.

• What are the 5 symptoms of PCOS? Common symptoms are irregular or missed periods, excess facial or body hair, acne, scalp hair thinning, and difficulty getting pregnant. Weight gain and signs of insulin resistance are also common. See PCOS symptoms explained for more.

• Do I need all these tests to diagnose PCOS? Not always. Testing depends on your symptoms and history. If you have irregular cycles and clear signs of high androgens, you already meet two criteria, and testing focuses on excluding other conditions and checking glucose and lipids.

• Can PCOS blood tests change over time? Yes. Hormone, glucose and insulin levels can change with age, weight, lifestyle and treatment. That is why the guideline recommends rechecking glycaemic status every one to three years.

• What is the best time in my cycle to test for PCOS? LH, FSH and estradiol are usually measured on cycle days 2 to 5. If your cycles are irregular, testing at a consistent time is a common approach. Glucose, insulin and lipid tests can be done on any day after fasting.

• Can I test while on birth control? The combined pill raises SHBG and lowers androgen production, so testosterone, SHBG, LH, FSH and AMH results are hard to interpret while taking it. The guideline says the pill should be stopped for at least three months if androgen testing is essential.

• Can you have PCOS with normal testosterone levels? Yes. You can meet the criteria with irregular cycles plus hirsutism or polycystic ovaries on ultrasound or AMH, even when testosterone is in range.

Related Articles

• PCOS symptoms explained: signs and lab tests

• PCOS and insulin resistance: causes, symptoms and insights

• Can PMOS cause high cortisol?

• Female hormone testing: a guide for women at every stage

Resources

• Teede, H. J., Khomami, M. B., Morman, R., Laven, J. S. E., Joham, A. E., Costello, M. F., Patil, M., Rees, D. A., Berry, L., Cree, M. G., Zhao, H., Norman, R. J., Dokras, A., & Piltonen, T. (2026). Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. The Lancet. https://doi.org/10.1016/s0140-6736(26)00717-8
• Teede, H. J., Tay, C. T., Laven, J., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., Mousa, A., Joham, A. E., & International PCOS Network. (2023). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertility and Sterility, 120(4), 767-793. https://doi.org/10.1016/j.fertnstert.2023.07.025
• The same guideline recommendations in The Journal of Clinical Endocrinology & Metabolism (2023), open access. https://doi.org/10.1210/clinem/dgad463
• Endocrine Society. (2026, May 12). Polyendocrine Metabolic Ovarian Syndrome: New name to improve diagnosis and care of condition affecting 170 million women worldwide. https://www.endocrine.org/news-and-advocacy/news-room/2026/pcos-name-change
• World Health Organization. (2026, January 22). Polycystic ovary syndrome. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
• Jiang, M., Wang, T., & Huang, L. (2026). Serum vitamin D levels in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis. Frontiers in Endocrinology, 17, 1839319. https://doi.org/10.3389/fendo.2026.1839319
• Diagnosis and management of polycystic ovarian syndrome. (2024). Canadian Medical Association Journal. https://pmc.ncbi.nlm.nih.gov/articles/PMC10833093
• https://doi.org/10.1016/j.endmts.2025.100228
• https://www.ncbi.nlm.nih.gov/books/NBK459251