Differential Endocrine Response to Levonorgestrel -IUDS In PCOS Phenotypes

Mariam Hashiru

Co-Presenters: Individual Presentation

College: Hennings College of Science Mathematics and Technology

Major: BS.CHEMISTRY/EXP

Faculty Research Mentor: Stokes-Huby, Heather  Mongelli, Mathew

Abstract:

Polycystic ovarian syndrome, which is known as PCOS, is a biochemically heterogeneous endocrine disorder that comes with varying combinations of hyperandrogegism, insulin resistance, ovulatory dysfunction, and structural abnormalities. Clinicians and researchers often treat PCOS as a homogeneous condition, but emerging evidence shows that distinct PCOS phenotypes demonstrate significant differences in steroid hormone production, metabolic regulation, and androgen biosynthesis. Doctors often prescribe levonorgestrel-releasing intrauterine devices (LNG-IUDs) for contraception and endometrial protection in PCOS patients, but these devices produce varying endocrine and metabolic effects depending on a patient’s biochemical profile.This study assesses how differences in steroidogenic pathways and hormone-receptor interactions among PCOS phenotypes can influence patient responses to levonorgestrel exposure. A structured literature analysis was performed to focus on steroid hormone signaling, androgen metabolism, insulin-mediated regulation of ovarian steroidogenic enzymes, and progestin receptor activity. The analysis also emphasizes the importance of considering how levonorgestrel's androgenic properties and systemic distribution can affect hyperandrogenic patients compared to those with metabolic dysregulation.Recognizing PCOS as a biochemically heterogeneous disorder helps explain why studies report inconsistent findings regarding LNG-IUD safety and efficacy. This analysis reveals that levonorgestrel offers therapeutic benefits in certain phenotypes but exacerbates hormonal or metabolic imbalances in others. Improved phenotype classification and biochemical profiling could enhance contraceptive decision-making and promote more individualized endocrine management strategies.Keywords: steroidogenesis, levonorgestrel, androgen biosynthesis, PCOS phenotypes, hormonal pharmacology