PCOS PART 3: The 4 Patient Types | Dr. Sara Gottfried


hey guys it’s Dr. Sara Gottfried I’m the board-certified obgyn who’s the author of several books including the hormone cure the hormone cure which is around here somewhere this is the book where I talk a lot about PCOS there’s an entire chapter on it on high androgen levels in which you can do about it the supplements that are proven to really make a difference and even though this book is a few years old it’s still totally current in terms of the science so that’s a place to go to for if you want more resources here’s what I want to cover today we talked about how PCOS confers this greater risk of cardiovascular disease to women and I really want women to care about heart disease because it kills us more often than breast cancer or weight or some of the issues that we struggle with and then in the second video part two I talked about how I diagnosed PC less the three things that I look for the three diagnostic criteria and in this video I want to answer some questions that you guys had about you know I’m someone who is lean but I I think I have PCOS or I’m someone who doesn’t have any hirsutism or weird hairs is a possible that I still have PCOS or I’m someone who has a regular cycle can I still have PCOS so I want to answers for those questions although please watch part two because I talked about some of those things in that video as well so I want to talk about the four different patient types that I see with PCOS okay so the first one is kind of a classical piece us and this is from as I mentioned in the last video a talk that I gave for the Cleveland Clinic so it’s as if you guys are at the Cleveland Clinic hearing me talk about this so this first group is cut a classic PCOS and that’s got three parts to it so this is phenotype number one patient population number one the first part is clinical and/or biochemical evidence of high androgen levels so I talked about that in the last video can be clinical acne hirsutism these wrote cares or it can be biochemical so we measure your blood your your testosterone high your free testosterone site your DG is high those are clinical and/or biochemical evidence of hyperandrogenism the second part of phenotype number one classical PCOS is evidence of all ago and ovulation so that’s OBGYN speak for having a period that’s every 35 days or longer in between the third is ultrasound evidence of polycystic ovaries so again I talked about that in the last video I kind of presented the classic case with some of the variances so I’d recommend going back and listening that if you didn’t catch it the second group is called phenotype 2 and that has some overlap with the classical piece us but this is based on National Institutes of Health criteria so these are women who have clinical and or biochemical evidence of hyperandrogenism as I just described for phenotype number one and they have evidence of all ago and ovulation so the thing that’s different here is it doesn’t require an ultrasound so these are two different diagnostic systems for diagnosing PCOS and so I get patients referred to me who’ve been diagnosed who are in that first group phenotype one and then I have other patients who are in this second group they’ve been diagnosed based on NIH criteria the third group is an answer to your question this is the ovulatory PCOS type of patient so this is phenotype 3 and what happens here is they have clinical and or biochemical or blood tests showing hyperandrogenism high testosterone levels high DHEA and then they have ultrasound evidence of a polycystic ovary but they’re having regular cycles now those regular cycles as they talked about in the last video could be completely normal or there can be some level of dysfunction going on in fact I see patients who’ve got regular cycles but they don’t have that Serg they don’t have a little luteinizing hormone surge before they you know right at the mid cycle before they have their period right on day 14 or 15 so that’s a third group some of you asked about this can I have regular cycles and still have PCOS the answer is yes this is phenotype number three and then here’s the fourth group and this is really important because the first three groups that I mentioned classic PCOS nih criteria PCOS phenotype two ovulatory PCOS the third group all three of these have the greater risk of cardiovascular disease but this fourth group phenotype four is non hyper androgenic PCOS and these are the folks who do not have an increased risk of cardiovascular risks they have a baseline risk that’s similar to other women meaning that you got a greater risk especially after you go through perimenopause and menopause so this is the group that has evidence of all ago and ovulation so they’re having a cycle that’s every 35 days or longer and then they have ultrasound evidence of a polycystic ovary so that’s the string of pearls sign I had my pearls on in the last video and I couldn’t think of string a pearl sign that’s the sign we’re looking for on ultrasound so these are women who don’t have any problems with their antigens but they are having irregular periods they’re not ovulating every cycle where they should be and then they have ultrasound evidence of a polycystic ovary so those are four different phenotypes that we see because I wanted to make sure that I answered this question do you know can’t I have regular cycles and still have PCOS and the answer is yes can I have PCOS but not have acne and hirsutism or a problem with my testosterone and the answer is yes that’s phenotype 3 and 4 respectively so I hope that answers more of your questions please leave more questions and comments below please share this with some people who need to hear it any women who are struggling with hormone imbalances I think a lot of hormone imbalances trace back to an issue with polycystic ovaries we’ll be talking about insulin in the next video in fact it’s something that won’t shut up about because I think it’s so important not just for women but for men too and so I want to thank you for joining me I hope you have a fantastic weekend and I’ll see you next time

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