Female Reproductive Endocrinology V Flashcards
Recall that peripheral fat expresses CYP19; thus this tissue can utilize the abundance of androstenedione and testosterone for the production of
Estrone (E1) and E2 respectively
Mildly, but chronically elevated E2 (generally in the mid-follicular phase range) with an increased E1: E2 ratio is common in
PCOS
These estrogens with elevated testosterone exert negative feedback on
FSH secretion
Many endocrine tissues can purportedly feed into PCOS, and these include the
Ovary, adrenal. and HPA
There are several genetic links coupled to PCOS inducing disruptions in
- ) Insulin sensitivty
- ) Androgen production
- ) Gonadotropin secretion
Regarding gonadotropin secretion and PCOS, an abnormally elevated GnRH pulse frequency is not uncommon, and this leads to an increase in
LH secretion while impairing FSH secretion
Recall that LH stimulates theca cell androgen production; and interestingly, insulin has a synergistic effect of
LH-stimulated androgen synthesis in theca cells
Androgen production (notably testosterone) is driven above that which occurs in normal ovaries with
Excess LH and slightly elevated Insulin
Of note is that abdominal obesity exacerbates many symptoms that can manifest during
PCOS
Glucose intolerance, insulin resistance, hyperandrogenemia, and others are examples of
Symptoms that we can see in PCOS
It should be mentioned that insulin resistance is essentially universal in the case of PCOS women with a body-mass index of
Greater than 30
How can we find BMI?
BMI = Weight (kg) / Height (m^2)
There is overlap in many of the symptoms of PCOS with those describing the
Metabolic syndrome
To summarize, the more “typical” PCOS phenotype is one of
Overweight w/ abdominal obesity, anovulation, and hyperandrogenism
First and foremost in the management of PCOS in overweight women is weight loss since this can reverse
Insulin resistance and hyperandrogenism
Has been correlated with restored ovulatory function and reduction in androgens in some PCOS women
Weight loss of 2-7%
Because of its effectiveness, lifestyle modifications should be considered as a first course of action in
Overweight PCOS women
Can help to normalize menstrual cyclicity and reduce any incidence of endometrial hyperplasia due to unopposed E2 seen in PCOS
The use of OCPs
A GnRH agonist which can assist in restoring normal gonadotropin secretion
Clomiphene
An insulin-sensitizing drug qhich by normalizing insulin responsiveness can assist in restoring ovulation
Metformin
Can aid in reversing hirsutism
-not commonly used
Antiandrogens (flutamide)
FSH (rFSH) can be used, but this technique is not routine since it can induce
Ovarian hyperstimulation syndrome