Many women have reached out to ask me to explain what their hormones look like if they have PCOS and this is a great follow up after looking at “normal cycles” and hormones for those on “the pill”.
PCOS is a hormonal disorder which is commonly diagnosed in young women. It was named for multiple cysts seen on the ovaries of patients diagnosed with PCOS, although this is a bit of a misnomer as patients with PCOS will not always have cystic ovaries.
Unlike the last two posts, it is much harder to provide a diagram of what hormones will look like in a cycle. This is because PCOS can present differently in various patients. Some people may have a 2-month cycle, some may not ovulate, and some may cycle regularly.
There are multiple female hormones that PCOS will affect like androgens, estrogen, and progesterone.
All females normally produce small amounts of androgens, like testosterone. In PCOS patients these androgens are usually greatly elevated.
One of the most common clinical patterns I see in PCOS patients is estrogen dominance. This happens when your estrogen levels are too high relative to progesterone levels. If you need a refresher on what estrogen dominance is click here. There are three forms of estrogen in our body- Estradiol (E2), Estrone (E1), and Estriol (E3). Premenopausal Estradiol should be the dominant form of estrogen. Postmenopausal Estrone takes over as the dominant from of estrogen and in pregnancy Estriol is dominant. In PCOS patients, I often see Estrone levels higher then Estradiol, this is problematic for these patients and can impact symptoms and fertility.
Progesterone levels are often decreased in PCOS.
LH and FSH are also hormones involved in a women’s menstrual cycle. In a “normal” female the ratio of LH to FSH is 1:1 (except right before ovulation) but in PCOS this ratio will often be abnormal.
Currently, the most widely accepted way is by using something called the Rotterdam criteria:
Two of three are needed to make the diagnosis:
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