Review Question - QID 100503

The patient is presenting with signs and symptoms consistent with polycystic ovarian syndrome (PCOS). Oral contraceptives (OCPs) are used in managing these patients. The endometrial protective hormone in the OCP is progesterone, which is involved in cervical mucus thickening.

Patients with PCOS are at increased risk of endometrial hyperplasia due to chronic anovulation. Estrogen-progestin contraceptives are considered first-line for protecting the endometrium from undergoing unopposed proliferation. This is due to daily progestin exposure. With regards to hirsutism, a clinical presentation secondary to androgen excess, estrogen-progestin contraceptives are considered first-line in most women. This is due to impairing gonadotropin secretion which would otherwise increase ovarian androgen secretion. It also increases sex hormone-binding globulin (SBHG) levels, thus decreasing free androgen concentrations.

The first step in answering this question is recognizing that the endometrial protective hormone the vignette is referring to is progesterone. This question requires your understanding of progesterone physiology. As mentioned before, progesterone has an anti-mitogenic effect on the endometrium. This antagonizes the endometrial proliferative effect of estrogen. Progesterone is also involved in thickening the cervical mucus. This subsequently impairs sperm penetration that would eventually lead to pregnancy.

Incorrect Answers:
Answer 1: Decreases thyroxine binding globulin (TBG) is incorrect. Estrogen is involved in increasing TBG levels.
Answer 3: Enhances tubal motility is incorrect. Progesterone does the opposite. It decreases tubal motility.
Answer 4: Decreases LDL is incorrect. Estrogen is involved with increasing HDL levels and decreasing LDL levels.
Answer 5: Increases bone fractures is incorrect. Estrogen replacement therapy can prevent pathologic bone loss.


Studies show that there is an association between polycystic ovarian syndrome (PCOS) and insulin resistance. Insulin resistance is linked to type 2 diabetes, atherosclerosis, hypertension, and so forth. Chronic anovulation, seen in PCOS, places the patient at risk for endometrial hyperplasia and carcinoma. Weight loss is the most important intervention. (1)