PCOS and osteoporosis - CAUSE?? -- misshyd / any1 - ikeratoconus

[ArchivalUser]

hi everyone,

in PCOS - whats the estrogen level like?

Dr. RED says -
anovulatory cycles in PCOD means - estrogen deficient - increased endometrial stripe - risk of endometrial cancer and osteoporosis

i have been thinking all this while ..

1) anovulation - no corpus luteum - no progesterone -
how does anovulatory cycle cause estrogen deficiency?

2) estrogen excess causes endometrial cancer
why does he say estrogen deficiency causes increased endometrial stripe

confused all together..
someone please help

thank you



moreove

PCOD pts are mostly obese too - that contributes to high estogen levels too

estrogen low - hence osteoporosis
But at the same time, the pt is at risk for endometrial hyperplasia which is due to excess unopposed estogens.

[ArchivalUser]

its very simple to understand.i will try to b very brief
keep in mind these patients r mostly obese

PCOS is mainly cause by 2 things(among others)
1)ovarian stimulatin by excess male hormones
2)insulin resistance/hyperinsulinemai

the main isuue is not estrogen deficiency or excess rather it is the relative excess and

dominance of male hormones and dominance of LH over FSH(LH:FSH >=2:1)
hyperinsulinemia increases GnRH pulse frequency, increased ovarian androgen production,

plus adipose tissue possesses aromatase, an enzyme that converts androstenedione to

estrone and testosterone. the excess of adipose tissue in obese patients creates the

paradox of having both excess androgens & estrogens which inhibits FSH via negative

feedback(hence less FSH as compared to LH)
i hope it makes sens now

[ArchivalUser]

thanks for ur response shigella..
in ur note, u too have said estrogen excess.. thats what i knew till i heard Dr. RED

what confused me is Dr. Red's explanation

my Q is WHY DOES DR.RED SAY - anovulatory cycle = estrogen deficient?

what i heard in kaplan step 2 was -

PCOS pts have stable estrogen level -
no LH surge -
so no ovulation -
no CL -
no Progesterone -
unopposed estrogen
endometrial hyperplasia

but DR Red says estrogen deficiency causes endometrial hyperplasia and osteoporosis..
HOWS THAT??

if estrogen is indeed excess in PCOS.. what causes Osteoporosis in these pts when they have enough of estrogens?

i tried googling.. spent around 2 hrs obscessed with estrogen and PCOD and BMD..
hence came to forum for help..

[ArchivalUser]

as to my knowledge, PCOS is not associated with osteoporosis and even estrogen is not decreased.
I cant comment about what u might have heard in the lecture that u r giving reference to. i have not heard that lecture, though i m quite curious :-)

[ArchivalUser]

i cant believe my own ears now..
just waiting for misshyd to clarify

wondering..
there are so many who are doing archer's.. but not a single one to help me out.. perhaps im the only one who isnt able to understand this.. or perhaps i have delusions.. !!!!!

MISSHYD.. pls help!

[ArchivalUser]

I agree with shigella.

[ArchivalUser]

i agree with shigella too.. so does that mean DR. Red is wrong?

[ArchivalUser]

moreover, Dr. RED says LH/FSH criteria isnt used for diagnosis of PCOS any longer.. i checked it up too.. there is an article in emedicine regarding that..

im going mad now.. i hate controversies..
just waiting for misshyd..

hasnt anyone who has done archer's heard what i have heard..

[ArchivalUser]

ikeratoconus...do not panic so much
many sources will give you different things depending on how updated it is. So far, the most updated in my view is archer.
One way to know correct guidelines is by going to society guidelines itself or check gynec society guiudelines if you have access.

PCOS is a difficult disease to pick up early...but few things are important and are the diagnostic criteria as explained in archer lecture :
1)androgenic excess - clinical or biochemical evidence, ( this is a must criteria and this androgen excess must not be explained by any other cause)
2) anovulation/ menstrual irregularity not explained by any other cause,
3) cystic ovaries on ultrasound unexplained by any other cause ( this is what is in dr.red lecture)
4) additional evidence includes obesity and insulin resistance

This diagnostic criteria has no mention of LH and FSH. If they ask you an MCQ with PCOS clinical feature and ask you about diagnosis with choices including testing for testosterone levels as one choice or LH/FSH as another choice, which one would you choose?
This is actually a real question. So, the answer for that MCQ would be testosterone level not the LH/FSH. This is how the concept clarity should be because diagnostic criteria has no mention of LH/FSH in it.

LH/FSH ratio is an adjunctive thing NOT INCLUDED in the the 4 diagnostic criteria mentioned above!! People who are still using it are not reading changing medicine . For our exam, if this is in the choices, it is not answer for diagnosing PCOS ...Here is your nedscape link saying LH/FSH should be totally abandoned : http://www.medscape.co m/viewarticle/500870_4

Uptodate also does not mention LH/FSH completely ( Uptodate says : the serum concentration of follicle stimulating hormone (FSH) may be normal or low in PCOS, leading to an elevated LH/FSH ratio compared with normally cycling, early follicular phase young control women. However, neither an elevated serum LH concentration nor an increased LH/FSH ratio are part of the diagnostic criteria for PCOS )

ask me if more qs, i have a calm day today

[ArchivalUser]

thanks misshyd..

i too clarified regarding the LH/FSH criteria. i completely agree with Dr. Red regarding that. he was quite clear when he explained that.

LH/FSH is NOT the issue that held me up..
my doubts are still unanswered..

in endo lectures, under PCOD - Dr. Red says

anovulatory cycles - estrogen deficient - endometrial hyperplasia - osteoporosis

my doubts..

1) how can anovulatory cycles be estrogen deficient?
i thought - stable estrogen levels without estrogen surge in PCO - no LH surge - no ovulation
i thought - anovulation - no CL- no progesterone

2) is estrogen level low in PCOS pts like what Dr. Red says?
firstly they are obese with adipose tissue making lots of estrogens and for other reasons that shigella has mentioned earlier in this post
secondly, when someone is at risk for endometrial hyperplasia, i think their estrogen is unopposed.

3) what is the reason behind osteoporosis in PCOD..?

i think i have delusions if someone says they havent heard Dr. Red saying these lines in endo lectures.