Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Nov 15:13:1017468.
doi: 10.3389/fendo.2022.1017468. eCollection 2022.

A review of the hormones involved in the endocrine dysfunctions of polycystic ovary syndrome and their interactions

Rebecca H K Emanuel  1 , Josh Roberts  1 , Paul D Docherty  1   2 , Helen Lunt  3   4 , Rebecca E Campbell  5 , Knut Möller  2
Affiliations
Review

A review of the hormones involved in the endocrine dysfunctions of polycystic ovary syndrome and their interactions

Rebecca H K Emanuel et al. Front Endocrinol (Lausanne). .

Abstract

Polycystic ovary syndrome (PCOS) affects up to 20% of women but remains poorly understood. It is a heterogeneous condition with many potential comorbidities. This review offers an overview of the dysregulation of the reproductive and metabolic systems associated with PCOS. Review of the literature informed the development of a comprehensive summarizing 'wiring' diagram of PCOS-related features. This review provides a justification for each diagram aspect from the relevant academic literature, and explores the interactions between the hypothalamus, ovarian follicles, adipose tissue, reproductive hormones and other organ systems. The diagram will provide an efficient and useful tool for those researching and treating PCOS to understand the current state of knowledge on the complexity and variability of PCOS.

Keywords: PCOS; endocrine; hormones; metabolic; reproductive.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
A simplified overview of the master diagram showing the key relationships and dysregulations of endocrine components in PCOS. Solid line arrows between features are used to indicated conversion or release. Dashed lines with diamond arrowhead connections are used to indicate influence. Dashed lines with arrowheads are used to indicate upregulation and dashed lines with reverse arrowheads are used to represent downregulation.
Figure 2
Figure 2
A diagram of the primary androgens, with colored arrows to represent how the androgens are changed by types of dysregulation.
Figure 3
Figure 3
A diagram of follicle growth, with red arrows to represent how polycystic ovarian morphology alters it.
Figure 4
Figure 4
A diagram showing the effects of LH and FSH dysregulation in PCOS.
Figure 5
Figure 5
A diagram of hypothalamic dysregulation in PCOS.
Figure 6
Figure 6
A diagram of the effects of AMH in PCOS.
Figure 7
Figure 7
Adrenal dysregulation in PCOS.
Figure 8
Figure 8
A diagram of the effects of insulin resistance and hyperinsulinemia in PCOS.
Figure 9
Figure 9
A diagram of the relationships of IGF-I and IGFBP-I in PCOS.
Figure 10
Figure 10
A diagram explaining SHBG and PCOS.
Figure 11
Figure 11
A diagram of how the thyroid and immune system could be dysregulated in PCOS.
Figure 12
Figure 12
A diagram of showing the relationships to prolactin in PCOS.
Figure 13
Figure 13
A diagram showing the dysregulation of adipose tissue in PCOS.
Figure 14
Figure 14
A diagram showing the dysregulation of the gut in PCOS.
Figure 15
Figure 15
Unifying diagram of PCOS reproductive and metabolic dysregulation. Colored arrows are used to show how various features of the diagram are increased or decreased by possible types of dysregulation or correlations between features. A colored ‘D’ is used to indicate when a feature is dysregulated by something. A colored ‘X’ indicates a relationship that no longer occurs due to a dysregulation. The colors used to represent types of dysregulation are as follows: dark blue for dysregulation in the hypothalamus, light blue for overactive theca cells and hyperandrogenism, red for PCOM, dark green for insulin resistance, light green for hyperinsulinemia, yellow for obesity, purple for adrenal dysregulation, pink for hyperprolactinemia, orange for an underactive thyroid and brown for gut microbiota dysregulation. Solid line arrows between features are used to indicated conversion or release. Dashed lines with diamond arrowhead connections are used to indicate influence. Dashed lines with arrowheads are used to indicate upregulation and dashed lines with reverse arrowheads are used to represent downregulation. Thin grey lines indicate weaker evidence.
See this image and copyright information in PMC

References

    1. Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome (PCOS): The hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Rev (2016) 37(5):467–520. doi: 10.1210/er.2015-1104 - DOI - PMC - PubMed
    1. Coyle C, Campbell RE. Pathological pulses in PCOS. Mol Cell Endocrinol (2019) 498:110561. doi: 10.1016/j.mce.2019.110561 - DOI - PubMed
    1. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. . Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clin Endocrinol (2018) 89(3):251–68. doi: 10.1111/cen.13795 - DOI - PMC - PubMed
    1. Ovalle F, Azziz R. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertility Sterility (2002) 77(6):1095–105. doi: 10.1016/S0015-0282(02)03111-4 - DOI - PubMed
    1. Venkatesan AM, Dunaif A, Corbould A. Insulin resistance in polycystic ovary syndrome: Progress and paradoxes. Recent Prog Hormone Res (2001) 56:295–308. doi: 10.1210/rp.56.1.295 - DOI - PubMed

Publication types