Women with PCOS have an increased LH:FSH ratio primarily 2:1. this results in increased activity of theca cells causing increased androgen production but because of low FSH there is decreased activity of granulosa cells causing decreased conversion of those androgens to estrogen. the excess androgens are then converted peripherally into estrone (estrogen) by aromatase present in tissues like adipose tissue. excess unopposed estrogen results in anovulatory cycles and endometrial hyperplasia (increasing the risk for endometrial cancer). excess testosterone results in alopecia and hirsutism. women with PCOS also exhibit a greater degree of insulin resistance than patients with the same BMI and visceral adiposity who do not have PCOS resulting in hyperinsulinemia (which causes acanthosis nigricans).

Patient has PCOS, characterized by -Increased insulin resistance (likely due to obesity - this is the inciting imbalance) -Increased testosterone (because of aromatase in adipose tissue converting estrogen to androgens) -Increased LH (characteristically, there is an increased LH:FSH ratio; according to FA, the increased insulin affects hypothalamic-hormonal feedback response to the pituitary)