Hormones in PCOD explained: FSH, LH, androgens and insulin

Hormones are chemical messengers. They travel in the blood and tell other parts of the body what to do. In a cycle, the brain sends signals to the ovaries, and the ovaries send signals back. In PCOD this conversation gets out of balance.

The brain part is the hypothalamus and the pituitary gland. Together they send FSH and LH to the ovaries. The ovaries answer with estrogen and progesterone, and the womb responds to both. A feedback loop tells the brain how much to send next. When one voice in the conversation is too loud or too quiet, the whole cycle shifts.

Here are the six you will hear about most.

FSH

FSH grows the egg sac each month. In a typical cycle it picks up early and helps one follicle mature. Doctors often check FSH together with LH, because the balance between the two says more than either alone.

LH

LH triggers egg release. A sharp surge in the middle of the cycle is the signal to ovulate. In PCOD LH is often higher, and the clean surge may not come, so the egg stays put.

Estrogen

Estrogen builds the womb lining each month. It also supports your skin and your bones. In PCOD estrogen is usually not missing. The trouble is that it keeps working on the lining without progesterone to balance it, which is one reason periods can turn heavy after a long gap.

Progesterone

Progesterone prepares the womb after ovulation. It is made by the empty follicle, so it only rises if an egg was released. In PCOD it is low. No progesterone rise is the signature of a cycle without ovulation.

Androgens

Androgens are hormones every woman makes in small amounts. The ovaries and the adrenal glands make them. In PCOD they run higher. Androgens make some hair follicles grow thick, dark hair, make oil glands more active, and make the follicles on the scalp shrink. That is the link to acne on the jawline, extra hair on the chin or upper lip, and a wider parting.

Doctors may look at free testosterone, SHBG and DHEA-S. SHBG is a protein that carries testosterone in the blood. DHEA-S is an androgen made mostly by the adrenal glands.

Insulin

Insulin moves sugar from the blood into your cells. In PCOD it is often high, because the cells respond poorly and the body makes extra to compensate. High insulin tells the ovaries to make more androgens. So a problem that looks like a skin or period issue can start with sugar handling. That is why a PCOD plan so often includes food, movement and sleep.

What breaks down inside the ovary

Inside the ovary, two types of cells talk to each other to grow and release an egg. In PCOD that signalling breaks down, and immature eggs may be released, or none at all. Add the high LH and high insulin, and the sacs stall. On a scan, those stalled sacs look like small dots. They are not harmful cysts.

Hormones that look like PCOD

Thyroid and prolactin problems can look like PCOD. They can cause irregular periods, tiredness, weight changes and hair fall. That is why doctors always test them too. Finding one of them is not a failure of the PCOD diagnosis. It might be the whole answer, or it might sit alongside PCOD. Either way, treating it matters.

A quick way to remember it

Picture a relay. The brain starts the race with FSH. The ovary grows a sac and passes on estrogen. LH fires the starting gun for ovulation. Progesterone finishes the cycle. In PCOD the baton is dropped in the middle, with LH, androgens and insulin shouting louder than they should and progesterone never arriving. The picture is simple on purpose. Real bodies are more varied, and your doctor reads yours.

What this means for you

Knowing the roles helps you read your own reports. A few gentle points:

• No one number decides it. Doctors look at the pattern together with your symptoms, history and scan.
• Normal ranges differ between labs and between people. Ask your doctor to explain the report, not just the flag.
• Hormone levels can change with the day of the cycle, so some tests are timed. Your doctor will say when.

You cannot fix hormones by guessing. Please do not start a supplement because an online list said it balances hormones. Take medicines and supplements only on your doctor's advice.

This is education, not a diagnosis. Your doctor decides what your pattern means and what to do next.