This woman has Polycystic ovarian syndrome. This can be deduced because of the high LH:FSH ratio (>2), high BMI, and presence of withdrawal bleeding in a progesterone withdrawal test. In polycystic ovarian syndrome, there is increased release of androgens from theca interna cells. These androgens can cause symtoms commonly associated with PCOS (hirsutism, acne) but can also be aromatized to estrogen in adipose tissue. The presence of estrogens in this form causes constant negative feedback on the hypothalamus and dysregulation in the appropriate levels of the gonadotropins (see here and here)
A progesterone withdrawal test is used to help determine the cause of amenhorria. If withdaral bleeding occurs, it means the patient has sufficient estradiol and the amenorrhia is due to anovulation. If no withdrawal bleeding occurs, it means the patient either has chronic anovulation without estrogen, a nonreactive endometrium, or a problem with uterine outflow. In our patient's case, she has withdrawal bleeding so she has anovulation, a common symptom of polycystic ovarian syndrome.
submitted by โcassdawg(1781)
This woman has Polycystic ovarian syndrome. This can be deduced because of the high LH:FSH ratio (>2), high BMI, and presence of withdrawal bleeding in a progesterone withdrawal test. In polycystic ovarian syndrome, there is increased release of androgens from theca interna cells. These androgens can cause symtoms commonly associated with PCOS (hirsutism, acne) but can also be aromatized to estrogen in adipose tissue. The presence of estrogens in this form causes constant negative feedback on the hypothalamus and dysregulation in the appropriate levels of the gonadotropins (see here and here)
Here is a comparison graph of the hormone levels in a normal menstrual cycle to PCOS.
A progesterone withdrawal test is used to help determine the cause of amenhorria. If withdaral bleeding occurs, it means the patient has sufficient estradiol and the amenorrhia is due to anovulation. If no withdrawal bleeding occurs, it means the patient either has chronic anovulation without estrogen, a nonreactive endometrium, or a problem with uterine outflow. In our patient's case, she has withdrawal bleeding so she has anovulation, a common symptom of polycystic ovarian syndrome.