Failure to have menses following progesterone withdrawal in a normal estrogenic woman with polycystic ovarian syndrome who menstruates with oral contraceptives.

PURPOSE: To evaluate a case of a normal estrogenic woman with amenorrhea and polycystic ovarian syndrome who fails to get menses after progesterone withdrawal but who menstruates with oral contraceptives.

METHODS

The following sera assays were obtained: total testosterone (T), free T, weakly bound T, dehydroepiandrosterone sulfate, 17 hydroxyprogesterone, estradiol, free thyroxin, thyroid stimulating hormone, prolactin, evening cortisol, LH and FSH.

RESULTS

The total testosterone was markedly elevated but the free testosterone was normal and the free and weakly bound testosterone was the high end of normal. The LH/FSH ratio was markedly increased consistent with the ultrasound findings of polycystic ovarian syndrome. Vaginal cytology showed a mixed high estrogen/high androgen effect and the endometrial thickness was only 5 mm. Twice she failed to have menses following progesterone withdrawal.

CONCLUSIONS

One hypothesized mechanism is that the high testosterone levels even though mostly in the bound form inhibited estrogen from causing adequate endometrial development.