HPO disorders
This WHO Type I ovarian dysfunction is characterized by low FSH and estrogen levels.
What is hypogonadotropic hypogonadism?
This pulsatile hypothalamic hormone’s increased frequency in PCOS preferentially stimulates LH over FSH.
What is GnRH?
This is the most common androgenic skin manifestation in people with PCOS
What is hirsutism?
Sheehan’s syndrome is a type of pituitary failure that leads to this WHO classification of ovarian dysfunction.
What is WHO Type I?
hypogonadotropic hypogonadism
This gonadotropic hormone is usually higher than normal in people with PCOS, contributing to excess androgen production.
What is luteinizing hormone (LH)?
Long-term polycystic ovary syndrome is associated with a roughly threefold increased risk of this metabolic condition.
What is type 2 diabetes mellitus?
The most common cause of premature ovarian failure, characterized by high FSH but low estrogen.
What is idiopathic?
These ovarian cells are overstimulated by LH in PCOS, leading to excess androgen production.
What are theca cells?
These are the 3 reproductive consequences of PCOS.
Anovulatory Infertility
Early pregnancy Loss?
Late pregnancy complications
(T/F) All people with polycystic ovaries have PCOS, but not all people with PCOS have polycystic ovaries according to the Rotterdam criteria.
F (at least 2 of the 3 features must be present for a diagnosis)
These hormones are measured to determine the WHO group of ovarian dysfunction.
What are FSH and estrogen?
High levels of this hormone suppress hepatic SHBG, increasing free androgen levels. This is a common feature of PCOS.
What is insulin?
These four long-term health risks are associated with PCOS.
Diabetes (3-fold increase)
Cardiovascular disease (IHD, hypertension)
Endometrial Cancer
Ovarian Cancer [2-3 fold increase]
What is a polycystic ovary?
20 or more follicles and more than 10ml ovarian volume
This is the most common cause of normogonadotropic, normogonadic ovarian dysfunction.
What is polycystic ovary syndrome (PCOS)?
These are the 3 main causes of follicular arrest in PCOS.
LH:FSH imbalance – Elevated LH relative to FSH → favors androgen production over follicle maturation.
Hyperandrogenism – Excess androgens from theca cells impair granulosa cell function and oocyte development.
Insulin resistance / hyperinsulinemia – Stimulates theca cells to produce more androgens and lowers SHBG → more free androgens.
MOA of Clomiphene
Antagonist in hypothalamus and anterior pituitary gland, partial agonist in the ovaries
Blocks oestrogen receptors in pituitary relief of negative feedback inhibition increased release of GnRH and gonadotropins ↑ FSH stimulate follicle growth oestrogen trigger signal LH surge ovulation
2 of the following 3 features must be present to diagnose PCOS according to the Rotterdam criteria.
Oligo-/anovulation
2. Hyperandrogenism
3. PCO on USS