Why PCOS may start in the brain, not the ovary

A hormone doctors use to estimate how many eggs remain may also be acting on the brain. Oluyemisi Famuyiwa is a reproductive endocrinologist and infertility specialist. This episode is based on her article "The brain signal that drives polycystic ovary syndrome," published on KevinMD. You will hear why anti-Müllerian hormone, or AMH, runs high in polycystic ovary syndrome, now renamed polyendocrine metabolic ovarian syndrome, and why new guidance lets doctors use age-adjusted AMH in the diagnosis. She explains the 2016 discovery of AMH receptors in the hypothalamus, and how a revved-up GnRH rhythm tips the pituitary toward LH and the ovaries toward androgens. She describes mouse studies in which blocking the AMH signal reversed the pathology, and early work on fezolinetant, a menopause drug with liver toxicity. Press play to hear why she hopes this condition may one day be treated at the level of the brain, and tailored to each patient.

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A note from Dr. Famuyiwa: When discussing AMH, I said it "doesn't tell us anything about the quantity." I meant quality. AMH is, of course, used as a marker of ovarian reserve/follicle quantity.