A young woman with irregular menses, hirsutism, and acne is most likely to have which pattern of hormonal abnormalities?

• A. LH:FSH <1
• B. LH:FSH >2.0 with increased insulin and glucose
• C. Decreased insulin
• D. Elevated FSH with low LH

Answer: (B)

In polycystic ovary syndrome, the hypothalamic-pituitary axis shifts toward more LH relative to FSH because of increased GnRH pulse frequency. This higher LH stimulates the ovarian theca cells to produce more androgens, leading to irregular menses, hirsutism, and acne. Insulin resistance is also common in PCOS, causing hyperinsulinemia and higher glucose levels; insulin amplifies ovarian androgen production and lowers SHBG, increasing free testosterone. So the hormonal pattern you’d expect is a high LH:FSH ratio (often >2:1) with evidence of insulin resistance. The other patterns don’t fit PCOS: a low LH relative to FSH wouldn’t drive androgen excess, decreased insulin wouldn’t reflect the metabolic feature, and elevated FSH with low LH points to ovarian failure rather than PCOS.