From the Guidelines
Elevated sex hormone-binding globulin (SHBG) in polycystic ovary syndrome (PCOS) is unusual and warrants further investigation, as PCOS is typically characterized by low SHBG levels due to insulin resistance and hyperandrogenism. According to the most recent study 1, PCOS is a complex syndrome with metabolic, reproductive, and psychological characteristics, and women with PCOS may present with cardiometabolic disorders. The relationship between SHBG and hormones is complex, and abnormal levels can significantly impact hormone balance throughout the body.
Possible explanations for elevated SHBG in PCOS include thyroid disorders, estrogen therapy, liver disease, or genetic variations affecting SHBG production. If you have PCOS symptoms with high SHBG, it is recommended to consult an endocrinologist for comprehensive hormone testing, including free testosterone, estradiol, thyroid function, and insulin levels. Treatment would depend on the underlying cause of the SHBG elevation rather than following standard PCOS protocols.
Some studies suggest that lifestyle modifications, such as regular exercise and a balanced diet, can be beneficial for women with PCOS, regardless of SHBG status 1. Additionally, medications like metformin may be recommended for patients with cardiometabolic features like abdominal obesity and insulin resistance 1. However, the optimal treatment approach for PCOS with elevated SHBG would require individualized care and consideration of the underlying causes of the elevated SHBG levels.
In terms of management, the American College of Obstetricians and Gynecologists (ACOG) recommends the use of combination oral contraceptive pills for long-term management of PCOS, which can help suppress androgen secretion and increase SHBG levels 1. However, this approach may not be suitable for all women with PCOS, particularly those with elevated SHBG levels, and alternative treatments may be necessary.
Overall, elevated SHBG in PCOS requires a comprehensive evaluation and individualized treatment approach to address the underlying causes and optimize hormone balance and overall health outcomes.
From the Research
SHBG Elevation and PCOS
- Sex hormone-binding globulin (SHBG) is a protein that binds to sex hormones, including testosterone and estrogen, and helps regulate their activity in the body.
- In women with polycystic ovary syndrome (PCOS), SHBG levels are often lower than normal, which can contribute to hyperandrogenism (high levels of male hormones) and other symptoms of PCOS.
Effects of Metformin on SHBG
- Metformin, a medication commonly used to treat type 2 diabetes, has been shown to have a positive effect on SHBG levels in women with PCOS 2, 3.
- However, the effect of metformin on SHBG is generally less pronounced compared to combined oral contraceptive pills (COCP) 2.
- One study found that metformin was inferior to COCP in increasing SHBG levels, with a mean difference of -118.61 nmol/L (95% CI -174.46, -62.75) 2.
Effects of Combined Oral Contraceptives on SHBG
- COCP have been shown to increase SHBG levels in women with PCOS, which can help reduce hyperandrogenism and improve symptoms 2, 3.
- One study found that COCP plus spironolactone was more effective than metformin in increasing SHBG levels and reducing hyperandrogenism 4.
Effects of Combination Therapy on SHBG
- Combination therapy with metformin and COCP may have a more pronounced effect on SHBG levels compared to either medication alone 3.
- However, the available data do not offer enough evidence to advocate for the standard use of combined treatment in PCOS, and further research is needed to determine the benefits and risks of combination therapy 3.