PCOD/PCOS Blood Tests: Complete Test List & Normal Ranges for Indian Women

Polycystic Ovary Syndrome (PCOS) - commonly called PCOD (Polycystic Ovarian Disease) in India - is one of the most prevalent yet underdiagnosed hormonal disorders among Indian women. Research published in the Journal of Human Reproductive Sciences estimates that PCOD affects 3.7% to 22.5% of Indian women of reproductive age, with the wide range reflecting differences in diagnostic criteria and study populations. The Indian Council of Medical Research places the figure at roughly 1 in 5 women in urban India.

Despite these numbers, most women discover they have PCOD only when they struggle with fertility, persistent acne, or unexplained weight gain. The core problem is a hormonal imbalance - and the most reliable way to identify it is through a targeted set of blood tests. This guide covers every blood test in a comprehensive PCOD panel, explains the normal ranges used by Indian labs, and helps you understand what your results actually mean.

PCOD vs PCOS: Are They the Same?

In clinical practice, PCOD and PCOS are often used interchangeably, though there is a subtle distinction. PCOD is a condition where the ovaries release many immature or partially mature eggs that eventually turn into cysts. PCOS is a metabolic disorder with broader systemic effects - it involves not just the ovaries but also insulin resistance, androgen excess, and long-term risks like type 2 diabetes and cardiovascular disease.

The internationally accepted medical term is PCOS, and it is the one used in clinical guidelines. For this article, we use both terms since Indian patients and doctors commonly use PCOD. Regardless of the label, the diagnostic approach and the blood tests required are the same.

How PCOS Is Diagnosed: The Rotterdam Criteria

PCOS cannot be diagnosed with a single blood test. The globally accepted Rotterdam criteria (2003) require at least two of the following three features:

1. Oligo-ovulation or anovulation - irregular periods (cycles longer than 35 days) or absent periods
2. Clinical or biochemical hyperandrogenism - signs of excess male hormones, either visible (acne, hirsutism, hair thinning) or confirmed by blood tests (elevated testosterone, DHEAS)
3. Polycystic ovaries on ultrasound - 12 or more follicles (2-9 mm) in one ovary, or ovarian volume greater than 10 mL

Crucially, other conditions that mimic PCOS must be ruled out first. This is why a blood test panel is essential - it not only confirms androgen excess and insulin resistance but also excludes thyroid disorders, hyperprolactinaemia, congenital adrenal hyperplasia, and Cushing's syndrome.

Complete PCOD/PCOS Blood Test Panel with Normal Ranges

The following table lists every blood test commonly included in a PCOD evaluation in India. Reference ranges are representative of those used by major labs like Thyrocare, SRL Diagnostics, Dr Lal PathLabs, and Metropolis. Always compare your values to the specific reference range printed on your lab report, as slight variations exist between labs and assay methods.

Timing matters: Hormonal tests (LH, FSH, testosterone, prolactin) should ideally be drawn on Day 2 or Day 3 of the menstrual cycle. Day 1 is the first day of full menstrual flow. For women with very irregular or absent periods, the doctor may order tests on any day.

Test	Normal Range (Female)	Unit	PCOD Significance
LH (Luteinising Hormone)	2 - 15 (follicular phase)	mIU/mL	Often elevated in PCOD; drives androgen production
FSH (Follicle Stimulating Hormone)	3 - 10 (follicular phase)	mIU/mL	Usually normal or low-normal in PCOD
LH:FSH Ratio	~1:1	Ratio	> 2:1 is suggestive of PCOD (not diagnostic alone)
Total Testosterone	15 - 70	ng/dL	Elevated in 60-80% of PCOS patients
Free Testosterone	0.5 - 3.2	pg/mL	More sensitive than total testosterone; often elevated
DHEAS (Dehydroepiandrosterone Sulfate)	35 - 430	mcg/dL	Adrenal androgen; mildly elevated in ~30% of PCOS
17-OH Progesterone	0.2 - 1.0 (follicular)	ng/mL	Rules out congenital adrenal hyperplasia (CAH)
AMH (Anti-Mullerian Hormone)	1.0 - 4.0	ng/mL	> 4.5 ng/mL suggestive of PCOD; reflects follicle count
Fasting Insulin	2.6 - 24.9	μIU/mL	Elevated in insulin-resistant PCOD; optimal < 10
HOMA-IR	< 2.5	Index	> 2.5 indicates insulin resistance
Fasting Blood Sugar	70 - 100	mg/dL	100-125 = prediabetes; > 126 = diabetes
HbA1c	< 5.7%	%	5.7-6.4% = prediabetes; reflects 3-month average
TSH	0.4 - 4.0	mIU/L	Rules out thyroid disorder mimicking PCOD
Free T3	2.3 - 4.2	pg/mL	Part of thyroid exclusion panel
Free T4	0.8 - 1.8	ng/dL	Part of thyroid exclusion panel
Prolactin	4.8 - 23.3	ng/mL	Elevated prolactin can cause irregular periods; must be ruled out

How to Read Your PCOD Panel: What Each Hormone Means

A lab report with 15+ parameters can be overwhelming. Here is what to focus on and how the hormones connect to each other in the context of PCOD.

LH and FSH: The Gonadotropin Pair

LH and FSH are produced by the pituitary gland and work together to regulate the menstrual cycle. FSH stimulates the growth of ovarian follicles, while LH triggers ovulation. In a normal cycle, both are present in roughly equal amounts during the early follicular phase.

In PCOD, the hypothalamus increases the pulse frequency of GnRH (gonadotropin-releasing hormone), which preferentially boosts LH production while FSH stays the same or drops. The result is an elevated LH:FSH ratio - typically 2:1 or higher. Excess LH stimulates the ovarian theca cells to produce more androgens (male hormones), which is the biochemical root of symptoms like acne, hirsutism, and hair thinning.

Testosterone and DHEAS: The Androgen Picture

Total testosterone measures both bound and unbound testosterone in the blood. It is elevated in 60-80% of women with PCOS. Free testosterone - the biologically active fraction - is often a more sensitive marker and may be elevated even when total testosterone appears normal.

DHEAS is an androgen produced primarily by the adrenal glands, not the ovaries. A mildly elevated DHEAS (up to 1.5 times the upper limit) is seen in about 30% of PCOS patients and suggests an adrenal contribution to androgen excess. A markedly elevated DHEAS (> 700 mcg/dL) warrants further investigation for adrenal tumours or congenital adrenal hyperplasia.

17-OH Progesterone: Ruling Out CAH

This test is included specifically to exclude non-classical congenital adrenal hyperplasia (NCAH), a genetic condition that can present identically to PCOS with hirsutism, acne, and irregular periods. An early morning follicular phase 17-OH progesterone level below 2 ng/mL generally rules out NCAH. Values above 2 ng/mL require an ACTH stimulation test for confirmation.

AMH: The Ovarian Reserve Marker

Anti-Mullerian Hormone is produced by the granulosa cells of small ovarian follicles. In PCOD, the ovaries contain an unusually high number of small antral follicles, which drives AMH levels well above normal. An AMH above 4.5 ng/mL is strongly suggestive of polycystic ovaries and correlates with the follicle count seen on ultrasound. Some researchers have proposed using AMH as an alternative to ultrasound in PCOS diagnosis, particularly in adolescents where transvaginal ultrasound may not be appropriate.

LH:FSH Ratio Explained: Why It Matters in PCOD

The LH:FSH ratio is one of the most frequently discussed markers in PCOD, but it is also one of the most misunderstood.

What a reversed ratio means: In a normal early follicular phase, LH and FSH are roughly equal (ratio of about 1:1). When the ratio exceeds 2:1 - for example, LH of 12 mIU/mL with FSH of 5 mIU/mL - it indicates that the pituitary is releasing disproportionately more LH. This excess LH overstimulates the ovaries to produce androgens while the relatively low FSH fails to support proper follicle maturation and ovulation. The follicles stall at an early stage, accumulate as cysts, and the cycle becomes anovulatory.

Important caveats: While a high LH:FSH ratio is characteristic of PCOD, it is not present in all cases. Studies show that only 40-60% of women with PCOS have a clearly elevated ratio. The ratio is also affected by body weight - obese women with PCOS often have lower LH levels (and thus a normal ratio) compared to lean PCOS patients. Therefore, a normal LH:FSH ratio does not rule out PCOD, and an elevated ratio alone is not sufficient for diagnosis.

Insulin Resistance in PCOD: The HOMA-IR Connection

Insulin resistance is the metabolic engine that drives PCOS in 60-70% of affected women. Understanding this connection is critical because it changes the treatment approach entirely.

How it works: When cells become resistant to insulin, the pancreas compensates by producing more insulin (hyperinsulinaemia). Excess circulating insulin has two damaging effects in PCOD. First, it directly stimulates the ovaries to produce more testosterone. Second, it reduces the liver's production of Sex Hormone Binding Globulin (SHBG), which means more free testosterone circulates in the blood. This creates a vicious cycle: insulin resistance worsens androgen excess, and androgen excess promotes central (abdominal) fat deposition, which further worsens insulin resistance.

HOMA-IR calculation: HOMA-IR is calculated using the formula: (Fasting Insulin in μIU/mL x Fasting Glucose in mg/dL) / 405. A value below 2.5 is considered normal. Values between 2.5 and 3.5 indicate moderate insulin resistance, and values above 3.5 indicate significant insulin resistance. Some labs report HOMA-IR directly; others provide the raw insulin and glucose values for your doctor to calculate.

Why this matters for treatment: If your PCOD panel shows insulin resistance (elevated fasting insulin, HOMA-IR > 2.5, or prediabetic HbA1c), your treatment plan will likely include metformin or inositol alongside lifestyle modifications. Without addressing insulin resistance, managing PCOD symptoms through oral contraceptives alone provides only partial relief.

Thyroid and PCOD: Why Thyroid Must Be Tested

Thyroid dysfunction and PCOD share a striking number of symptoms - irregular periods, weight gain, hair loss, fatigue, and difficulty conceiving. This overlap makes it essential to test thyroid function as part of any PCOD evaluation.

Hypothyroidism mimics PCOD: An underactive thyroid can cause menstrual irregularity, elevated prolactin (which further disrupts ovulation), and even polycystic-appearing ovaries on ultrasound. A woman with untreated hypothyroidism may be misdiagnosed with PCOD if thyroid tests are not included in the workup. Correcting the thyroid imbalance alone may restore normal periods in these cases.

PCOD increases thyroid disease risk: Research published in the European Journal of Endocrinology found that women with PCOS have a 3-fold higher prevalence of autoimmune thyroiditis (Hashimoto's disease) compared to the general population. This means that even if your thyroid is currently normal, it should be monitored periodically if you have PCOD.

What to look for: A TSH above 4.0 mIU/L with low Free T4 suggests hypothyroidism. A TSH between 2.5 and 4.0 in a woman trying to conceive may also warrant treatment. If TSH is abnormal, Anti-TPO antibodies should be tested to check for autoimmune thyroiditis.

Indian-Specific Lifestyle Factors and PCOD Management

PCOD management in India requires attention to cultural and dietary factors that are different from Western recommendations.

Diet: PCOD-Friendly Indian Foods

The core dietary principle in PCOD is managing insulin resistance, which means reducing refined carbohydrates and increasing fibre, protein, and healthy fats. Here is how to apply this within an Indian dietary context:

• Replace white rice with millets - ragi (finger millet), jowar (sorghum), and bajra (pearl millet) have a lower glycaemic index and are rich in fibre. Ragi dosa, jowar roti, and bajra khichdi are excellent swaps.
• Include dal and legumes at every meal - moong dal, masoor dal, chana, and rajma provide plant protein and soluble fibre that slow glucose absorption.
• Add seeds - flaxseeds (alsi) contain lignans that may help reduce free testosterone. One tablespoon of ground flaxseed daily in curd or smoothie is a simple addition.
• Use fenugreek (methi) - research suggests fenugreek seeds may improve insulin sensitivity. Soaking one teaspoon of methi seeds overnight and consuming them in the morning is a common practice.
• Limit maida, packaged snacks, and sugary drinks - these cause rapid insulin spikes that worsen PCOD.
• Include healthy fats - nuts (almonds, walnuts), coconut, and ghee in moderation support hormone production without driving insulin resistance.

Exercise Recommendations

Physical activity is one of the most effective interventions for PCOD, particularly for improving insulin sensitivity. Research shows that even a 5-7% reduction in body weight can restore ovulation in overweight women with PCOS.

• 150 minutes per week of moderate exercise - brisk walking, cycling, or swimming
• Strength training 2-3 times per week - building muscle mass improves insulin sensitivity more effectively than cardio alone
• Yoga - studies from Indian institutions including AIIMS and NIMHANS have shown that regular yoga practice reduces testosterone levels, improves menstrual regularity, and lowers anxiety in women with PCOS. Specific asanas such as Supta Baddha Konasana, Bharadvajasana, and Shavasana are recommended.
• Avoid excessive high-intensity exercise - extreme exercise can raise cortisol levels, which may worsen hormonal imbalance in some PCOD patients

Stress and Sleep

Chronic stress elevates cortisol, which in turn raises insulin and androgen levels. Indian women with PCOD should prioritise 7-8 hours of sleep and consider stress management through meditation, pranayama, or counselling. Disrupted sleep - common in IT professionals working night shifts - is independently associated with worsened insulin resistance and hormonal imbalance.

When to See a Gynaecologist vs an Endocrinologist

This is a common source of confusion. Here is a practical guide:

See a gynaecologist first if:

• Your primary complaints are irregular periods, heavy bleeding, or difficulty conceiving
• You need a pelvic ultrasound and initial hormonal workup
• You are seeking treatment with oral contraceptive pills for cycle regulation
• You need fertility treatment (ovulation induction, IUI, IVF)

See an endocrinologist if:

• You have significant insulin resistance (HOMA-IR > 3.5) or have been diagnosed with prediabetes or type 2 diabetes
• You have thyroid dysfunction alongside PCOD
• You have markedly elevated DHEAS or suspicion of adrenal pathology
• Your symptoms are not improving despite standard gynaecological treatment
• You have metabolic syndrome (central obesity, high triglycerides, low HDL, hypertension)

In many cases, a collaborative approach works best. The gynaecologist manages the reproductive aspects (cycle regulation, fertility), while the endocrinologist addresses the metabolic components (insulin resistance, thyroid, adrenal function). In India, reproductive endocrinologists - specialists trained in both disciplines - are available at tertiary centres like AIIMS, Manipal Hospital, and Apollo Fertility.

Frequently Asked Questions

What blood tests are needed to diagnose PCOD/PCOS?

A comprehensive PCOD/PCOS blood panel typically includes LH, FSH, total and free testosterone, DHEAS, 17-OH progesterone, AMH, fasting insulin, fasting glucose, HbA1c, thyroid profile (TSH, T3, T4), and prolactin. Your doctor may also order a lipid profile and pelvic ultrasound. Blood tests should ideally be done on Day 2 or Day 3 of your menstrual cycle for accurate hormonal readings.

What is a normal LH:FSH ratio, and what does it mean in PCOD?

In a normal menstrual cycle, the LH:FSH ratio is approximately 1:1. In PCOD/PCOS, this ratio is often reversed to 2:1 or even 3:1, meaning LH is disproportionately elevated compared to FSH. This hormonal imbalance disrupts normal ovulation. However, a normal LH:FSH ratio does not rule out PCOS, as not all women with the condition show this pattern.

Can PCOD be diagnosed with blood tests alone?

No. PCOD/PCOS diagnosis follows the Rotterdam criteria, which require at least two of three features: irregular or absent periods, clinical or biochemical signs of excess androgens, and polycystic ovaries on ultrasound. Blood tests confirm the biochemical component - elevated androgens, abnormal LH:FSH ratio, insulin resistance - but a clinical evaluation and often an ultrasound are also needed for a definitive diagnosis.

On which day of my period should I get PCOD blood tests done?

Hormonal blood tests for PCOD - including LH, FSH, testosterone, and prolactin - should ideally be done on Day 2 or Day 3 of your menstrual cycle (Day 1 is the first day of full flow). If your periods are very irregular or absent, your doctor may order the tests on any day. Fasting insulin and glucose tests require 10-12 hours of fasting and can be done on any day.

What is HOMA-IR and why is it important in PCOD?

HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) is a calculated index using your fasting insulin and fasting glucose levels. A HOMA-IR value below 2.5 is considered normal. Values above 2.5 indicate insulin resistance, which is present in 60-70% of women with PCOS, including many lean PCOS patients. Identifying insulin resistance is critical because it drives androgen excess and can be managed with lifestyle changes and medications like metformin.