Clinical meaning
Polycystic ovary syndrome (PCOS) is a complex endocrine disorder driven by hypothalamic-pituitary dysfunction resulting in elevated GnRH pulsatility, increased LH-to-FSH ratio, and thecal cell hyperandrogenism. Insulin resistance, present in 50-70% of affected women regardless of BMI, amplifies ovarian androgen production by stimulating thecal cells and suppressing hepatic sex hormone-binding globulin (SHBG) synthesis. The resulting hyperandrogenism disrupts follicular maturation, causing anovulation and the characteristic polycystic ovarian morphology with multiple small antral follicles arrested at 2-9 mm.