A 32-year-old woman is presented to the gynecology clinic with infrequent periods. A hormone profile is done and all of the following are consistent with polycystic ovarian syndrome except
A. Increase androgen level
B. Normal FSH
C. Normal oestradiol
D. Decrease LH
Correct Answer: D. Decrease LH
Explanation
For PCOS (Polycystic Ovarian Syndrome), the typical hormone profile shows:
Hormone findings consistent with PCOS
- ↑ LH (often high LH:FSH ratio > 2:1)
- Normal or ↓ FSH
- ↑ Total and free testosterone
- ↑ DHEAS (androgens)
- ↑ AMH (due to increased antral follicles)
- Normal or ↑ Insulin levels / insulin resistance
- Normal prolactin (although mild elevation can occur)
Therefore, the finding that is NOT consistent with PCOS (“EXCEPT”) is:
High FSH level
FSH is not elevated in PCOS. If FSH is high, think of primary ovarian insufficiency or perimenopause, not PCOS.
Other Option Details
Here are the descriptions of all the options related to hormone profile findings in polycystic ovarian syndrome (PCOS):
A. Increased androgen level
- Women with PCOS typically have elevated androgens.
- Common raised androgens include testosterone, DHEAS, and androstenedione.
- This causes symptoms such as:
- Hirsutism (excessive hair growth)
- Acne
- Male-pattern hair loss
- This is a characteristic feature of PCOS.
B. Normal FSH
- In PCOS, the FSH level is usually normal.
- Ovulation is impaired, but FSH does not increase.
- Typical ratio of LH : FSH becomes > 2:1, mainly due to increased LH.
- Normal FSH is consistent with PCOS.
C. Normal oestradiol
- In PCOS, oestradiol (estrogen) levels are usually normal or slightly raised, but rarely low.
- Chronic anovulation leads to continuous but moderate estrogen production.
- Progesterone remains low because ovulation does not occur.
- Normal estradiol is consistent with PCOS.
D. Decreased LH
- In PCOS, LH is typically increased, not decreased.
- Elevated LH contributes to:
- Increased androgen production from the theca cells
- Disruption of normal ovulation
- Decreased LH is NOT consistent with PCOS.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group