Well, my endocrine and female thoughts are getting all screwed up..... PCOS presents with high levels of LH, low levels of FSH, and excess androgen production. Okay. I'm looking at a case where the patient has these things, plus endometrial thickening and secondary amenorrhea lasting 8 months (and all the other PCOS things you'd see)

I am really confused by this. So if you have decreased FSH, you would have a decreased proliferative phase, right? But if you have increased LH, wouldn't that cause ovulation??? Or is the FSH low enough that there is no mature follicle? And if that's true, then why the endometrial change? I don't get the hormonal mechanism for the "polycystic" part, or the thickened endometrium.

Something's not clicking...help me out! Thanks a lot

andy

adipocytes makes estrogen. women with polycystic ovarian disease is typically obese, and the xtra fat is contributing to the estrogen->endo thickening

ah, yes....i forgot about that

thanks!

plus you need an LH surge to actually have ovulation--a steady state high level of LH will actually keep ovulation from occuring (and to have the surge you need a certain level of FSH, so...)- no ovulation and you get ova that mature but don't pop...thus the polycystic ovaries (look like beads on a chain on U/S).

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It’s important to note that PCOS ‘MAY’ present with high levels of LH, low levels of FSH, and excess androgen production. Not all women with PCOS have “abnormal” hormone levels, nor do they necessary present with an abnormal LH:FSH ratio. I have severe PCOS but my LH:FSH ratio was always 1:1. It is important to test every year to get a history and a guide. What may be normal for guidelines may not be normal for the individual. Having a yearly panal is very imporant! I would also suggest a 4 hour GTT every 2 years - some women may not surge until the 3rd or 4th hour and can be missed in a 2hr GTT.

“women with polycystic ovarian disease is typically obese”
Actually, up to half of women with PCOS are not overweight. ‘Typically’ is not the right word to use. Unfortunately, it is true that many women do not get diagnosed until they have weight problems, thus the reason why many doctors do not see a PCOS patient until they have reached obesity and that is what needs to change.

I would also like to add a few things for you to take with you for future patients.

PCOS and PCO are not the same thing. They are two different diagnosis’. Some doctors, believe it or not, do not differentiate the two. This has a negative impact on PCOS education and understanding. A woman can have PCO at any time in their lives and it does not necessarily mean they have any health issues at all during a temporary situation. Having PCO does not make a patient PCOS and vice versa. As much as 30% of all women with PCOS do not have cyst issues. I am included in that percentage and have never had cysts.

Some women with PCOS will present “within normal ranges” of all hormones. This makes it especially difficult to diagnose.

Birth control pills are NOT a treatment for PCOS. In fact, they do more harm then good. The main purpose for prescribing birth control pills are to regulate menstrual and shed lining. Both can be aided by other resources that are better for the PCOS patient. Provera will shed the lining. Inducing menstrual with birth control pills takes away the patients thermostat. A menstrual is one of the first signs something is wrong which would send the patient to the doctor for testing. I agree shedding the lining is important but it should be done in other ways, such as Provera or actually treating the PCOS. Secondly, when you use birth control pills it does not completely stop stimulation to the ovaries, it just stops the release of mature eggs. Women with PCOS have a harder time absorbing them and instead they turn into cysts, thus increasing androgens. Lastly, it has come to light that birth control pills increase insulin issues, the last thing we need is more insulin problems. If a woman wants to prevent pregnancy, an alternet route is suggested, preferably something without hormones.

A hysterectomy will not rid of PCOS (an endocrine/metabolic disease), may come with other complications and should be an absolute last resort. Alternative routes would be advised before looking into a hysterectomy.

(Food for thought: One thing has always baffled me.No matter the age of the patient, a doctor will perform a hysterectomy without trying alternatives if there are medical issues that may be corrected with alternative solutions but too many women living childfree have to fight a loosing battle to have a partial for permanent birth control. Hmm)

Angi Ingalls; PCOS in ConnecTion
I am not a medical professional, but do have 18+ years educating others
on PCOS, prediabetes and diabetes.
1983 Dx Spina Bifida Occulta, Kidney/Liver issues
1985 Dx PCOS; 2006 Partial Thyroidectomy
http://pcos.itgo.com (PCOS Info Center)
http://pcosinct.999.org (Public PCOS Forums)
http://pcos.insulitelabs.com/blog/index.php
http://www.pcosupport.org