SHBG and anemia: Girls with obesity and polycystic ovary syndrome are significantly more likely to have heavy menstrual bleeding and iron deficiency anemia as a result of higher blood serum estrogen concentrations and endometrial hyperplasia, as well as increased clinical signs of hyperandrogenism, higher total and free testosterone levels, lower sex hormone binding globulin (SHBG) levels and compensatory hyperinsulinemia with insulin resistance (2).