The Complex Relationship between Hypothalamic Amenorrhea and Polycystic Ovary Syndrome

Abstract

Women with HA/PCOM may have inherently hyperandrogenic ovaries but are quiescent due to low gonadotropins from the hypothalamic inactivity. The exaggerated ovarian androgen response to low-dose gonadotropin stimulation in these women is consistent with the clinical observation that hyperandrogenism emerges in association with weight gain and the recovery of hypothalamic function. Over time, these patients may fluctuate between symptoms of HA and PCOS, depending on the current status of hypothalamic activity. The fluidity of this transition in HA/PCOM challenges the simple dichotomous definition of PCOS using the Rotterdam criteria, which categorizes the two conditions as being mutually exclusive.