PATHOPHYSIOLOGY

SHBG Diabetes Mellitus Obesity LH production

Insulin Resistance Insulin production

Hyperinsulinemia

p450 enzyme mRNA Expression (CYP17A1)

Adrenals

LH Steroidogenic activity

Estrogen
Testosterone Ovaries

Estradiol by aromatase Legend RED: From patient

Circulating Androgens
Peripheral Conversion of Androstenedione to Estrone by aromatase

Convertion of Estrone to Estradiol by 17B-HSD

Mitogenic Endometrial Stimulation

Endometrial Proliferation

Incomplete withdrawal bleeding

Normal/decrease level of progesterone; increased level of estrogen

Unopposed Estrogen/ Estrogen Dominance

Endometrial Cancer

Endometrial hyperplasia

AUB
Family History of Endometrial cancer Thickened Endometrial Lining (On UTZ)