Increased neuronal activity and axon-glial signalling in the hypothalamus of women with PCOS. Magnetic Resonance Spectroscopy (MRS) analysis of the hypothalamus (a) and thalamus (b) using the volumes of interest shown in a and b, respectively. (c) Representative typical spectrum of proton MR spectroscopy spectrum of hypothalamus along with molecular assignment of resonances (NAA: N-acetyl-aspartate at 2.02 ppm; Cr: creatine at 3.01 ppm; Cho: choline at 3.22 ppm). (d and e) Ratio of the concentrations of NAA to total Cr (creatine + phospho-creatine) in the hypothalamus (d) and thalamus (e) of healthy participants (n = 17) and PCOS volunteers (n = 23). (f and g) Ratio of the concentrations of Cho to total Cr in the hypothalamus (f) and thalamus (g) of healthy women (n = 17) and PCOS women (n = 23). ∗∗P < 0.01, n.s: not significant, Wilcoxon–Mann–Whitney test. The horizontal line in each plot corresponds to the median value. The vertical line represents the 25th–75th percentile range. Abbreviations: CC, corpus callosum; Cd, caudate nucleus; cp, cerebral peduncle; fx, fornix; LV, lateral ventricle; opt, optic tract, Th, thalamus.