Luteinizing Hormone to Follicle-Stimulating Hormone Ratio Significantly Correlates With Androgen Level and Manifestations Are More Frequent With Hyperandrogenemia in Women With Polycystic Ovary Syndrome

Md. Shahed Morshed, Hurjahan Banu, Nazma Akhtar, Tania Sultana, Afroza Begum, Moriom Zamilla, Sadiqa Tuqan, Sukanti Shah, Ahmed Hossain, Shazia Afrine, Emran Ur Rashid, Iffat Ara Jahan, M.A. Hasanat


Background: Altered luteinizing hormone to follicle-stimulating hormone (LH-FSH) ratio and hyperandrogenism are two important pathophysiological characteristics of polycystic ovary syndrome (PCOS). The aim of this study was to evaluate the relationship of LH-FSH ratio with androgen in women with PCOS.

Methods: This cross-sectional study included 550 newly detected reproductive aged women with PCOS (mean standard deviation (SD): age 23.14 4.80 years; body mass index (BMI) 27.64 5.34 kg/m2) according to revised Rotterdam criteria. Relevant clinical history, physical examination and ultrasonogram of ovaries were done for each participant. Fasting serum LH, FSH and total testosterone (TT) were measured by chemiluminescent microparticle immunoassay from blood collected during follicular phase of menstrual cycle.

Results: More than two-thirds (n = 389, about 71%) had altered LH-FSH ratio (cut-off > 1.0) and about 43% (n = 234) had hyperandrogenemia (TT > 46 ng/dL). Frequency of none of the clinical variables or ovarian morphology differed statistically between the groups with or without altered LH-FSH ratio (NS for all). Serum TT and LH-FSH ratio were positively correlated (r = 0.139, P = 0.001). However, menstrual irregularity (P = 0.002), polycystic ovaries (P = 0.045), diabetes mellitus (P = 0.017), obesity (P = 0.009) and hirsutism (P < 0.001) were higher in frequency in the hyperandrogenic group. Serum TT had predictive association with altered LH-FSH ratio (odds ratio (OR) (95% confidence interval (CI)): 1.09 (1.02 - 1.16), P = 0.02) and LH-FSH had predictive association with hyperandrogenemia (OR (95% CI): 1.15 (1.03 - 1.28), P = 0.02) in women with PCOS.

Conclusions: Serum LH-FSH ratio and androgenemia significantly correlate in women with PCOS. However, manifestations are more frequent with hyperandrogenemia rather than altered LH-FSH ratio.

J Endocrinol Metab. 2021;11(1):14-21


PCOS; LH-FSH ratio; Androgen; Hyperandrogenemia

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