Observational studyClinical endocrinology2026
Reassessing the Luteinizing Hormone/Follicle-Stimulating Hormone Ratio in Polycystic Ovary Syndrome: Associations With a Possible Neuroendocrine and Anti-Müllerian Hormone-Related Phenotype.
Observational study in Clinical endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
purposeTo comprehensively reassess the clinical and metabolic significance of the luteinizing hormone (LH) to follicle-stimulating hormone (FSH) ratio in women with polycystic ovary syndrome (PCOS), and to investigate whether it is associated with a clinical and hormonal pattern consistent with a possible neuroendocrine-dominant subgroup, distinguishable from insulin-related metabolic presentation.
designObservational cross-sectional study.
methodsThis retrospective cross-sectional study included 316 women diagnosed with PCOS according to the Rotterdam criteria at a tertiary university hospital. Patients were categorised based on their LH:FSH ratio (using a cut-off of 2) and their PCOS phenotypes (Phenotypes A, B, C, and D). Clinical, hormonal, and metabolic parameters, including anti-Müllerian hormone (AMH) levels and ovarian volume, were compared across groups.
resultsAmong 316 patients, 18.35% had an LH:FSH ratio >2. A strong positive correlation was found between LH:FSH ratio and AMH levels (r = 0.65, p < 0.001), and a significant correlation was observed with ovarian volume (r = 0.20, p = 0.001) and polycystic ovarian morphology (mean LH:FSH 1.59 vs. 1.15, p < 0.001). Patients with phenotype D (OA + PCOM, non-hyperandrogenic PCOS) exhibited the highest LH:FSH ratio (1.75 ± 0.87). Higher LH:FSH ratios were associated with oligo/amenorrhea (1.59 vs. 1.22, p < 0.001), anovulation (1.66 vs. 1.16, p < 0.001), and lower midluteal progesterone (ρ = -0.28, p < 0.001), but not with serum androgens or Ferriman-Gallwey scores. Weak positive correlations were observed with insulin levels (ρ = 0.18, p = 0.022) and HOMA-IR (ρ = 0.18, p = 0.021), but no significant associations were found with BMI, glucose tolerance, or lipid profile.
conclusionA high LH:FSH ratio is associated with a clinical and hormonal pattern-including elevated AMH levels, prominent PCOM, and anovulation-that may be consistent with a neuroendocrine-dominant presentation of PCOS, rather than metabolic or androgenic disturbances. If confirmed by prospective studies, this association could inform more individualised therapeutic approaches.
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