ABSTRACT
Polycystic Ovarian Syndrome (PCOS), and its associated insulin resistance, can cause significant abnormal uterine bleeding. PCOS is a constellation of obesity, insulin resistance, and oligo, or anovulation that can result in infertility, menstrual dysfunction, and hirsutism. As women become obese, they become insulin resistant, resulting in elevated levels of circulating insulin. Insulin suppresses the synthesis of sex hormone binding globulin (SHBG), which is crucial in binding free androgens. Oral contraceptives are effective for some of the symptoms of PCOS, including acne, irregular, heavy bleeding and hirsutism, as they lower total testosterone levels and increase SHBG, but they can have a negative impact on lipid profiles. In a normal menstrual cycle, small increases in Follicle-Stimulating Hormone stimulate the ovary to develop a follicle, which produces rising levels of estrogen, causing the endometrial lining to thicken and the pituitary to release a very large amount of luteinizing hormone.
