What is the interpretation of elevated Follicle-Stimulating Hormone (FSH) at 14.1 International Units per Liter (IU/L) and elevated Luteinizing Hormone (LH) at 32.8 IU/L?

From the Guidelines

The FSH level of 14.1 IU/L and LH level of 32.8 IU/L, with an LH:FSH ratio of approximately 2.3:1, suggest a hormonal imbalance that is more indicative of polycystic ovary syndrome (PCOS) rather than functional hypothalamic amenorrhoea (FHA), as the ratio exceeds 2:1, which is often seen in PCOS patients 1. Given this hormonal pattern, it is crucial to consider symptoms such as irregular periods, acne, excess hair growth, or difficulty conceiving, which are commonly associated with PCOS.

• The diagnosis of PCOS or FHA should be based on a comprehensive evaluation including a focused history, physical examination, pelvic ultrasound, and laboratory tests, as suggested by Schlaff and Coddington (2020) 1.
• The use of the LH to FSH ratio as a diagnostic tool is supported by recent data showing that a ratio <1 is seen in about 82% of FHA patients, whereas in PCOS, the ratio often exceeds 2 1.
• Management of PCOS may involve lifestyle modifications, such as weight management, which can improve hormone balance, as well as medical treatments including combined hormonal contraceptives, metformin, or anti-androgens like spironolactone.
• It is essential to consult with an endocrinologist or gynecologist for a complete evaluation and personalized treatment plan, as the diagnosis and management of PCOS or FHA require a comprehensive approach considering the patient's specific symptoms, medical history, and laboratory findings.

From the Research

Hormone Levels

• Follicle-Stimulating Hormone (FSH) level: 14.1 IU/L
• Luteinizing Hormone (LH) level: 32.8 IU/L

Interpretation of Hormone Levels

• The FSH level is within the normal range for women of reproductive age, indicating that the ovaries are functioning properly 2.
• The LH level is elevated, which can be associated with polycystic ovary syndrome (PCOS) 3, 4, 5.

Treatment Options for PCOS

• Clomiphene citrate is often used as a first-line treatment for ovulation induction in women with PCOS 3.
• Metformin can be used in combination with clomiphene citrate to improve ovulation rates and pregnancy outcomes 3, 5.
• Letrozole is an alternative treatment option for women with PCOS who are resistant to clomiphene citrate 4, 6.
• Gonadotropin formulations can be used for in vitro fertilization (IVF) programs in women with PCOS 6.

Considerations for Treatment

• The choice of treatment depends on the individual patient's needs and medical history 6.
• The use of LH in combination with FSH in controlled ovarian stimulation remains controversial, but may be beneficial for specific groups of patients 2.