In this episode, we are going to continue talking about the Types of PCOS that we have seen. As we have said, (repetitively) PCOS is not a one size fits all. There are some women that have most of the symptoms to just a few. We have three types that we have seen in treating patients since 2004. It is important to have this distinction when it comes to health goals and treatment plans. Doctors that routinely treat PCOS will tell you there are different types. They might have their types that they have seen. But in our experience, these are three types that we have seen most regularly.
The three types of PCOS 

Classic
Common
Concealed

Concealed: This type of PCOS is never picked up on. These are the women that have gone to many doctors looking for answers. This is because they have just a small few of the symptoms but not enough to point to PCOS. But they do have a hormone imbalance, and when you break it down, it is a type of PCOS. It seems to get worse when a Concealed Type hits perimenopause or late 30's to early 40’s. The female hormones are changing, and the body cannot maintain.   
This is typically what you will see in the Concealed-Type:

May have a child, so it looks like there are no fertility issues
Really irritable–all the time, and way worse before their period
Yes, they have regular periods but the worst PMS
Anxiety –it seems that they have a lot of low-grade anxiety all the time.
Hair is thin
Slender until they hit mid to late 30's to early 40’s. This is when they gain weight, especially in the stomach. No matter what they do, they cannot lose weight. Even with severe caloric restriction and lots of crazy exercise, there is no real budge to the weight.
Carbohydrate cravings especially for sugar
All these symptoms of the Concealed are blown off as genetics or lifestyle. I have had so many patients with Concealed PCOS say that their previous doctors did not believe that they had a healthy lifestyle.

This is what their blood work typically looks like:

LH : FSH ratio : the LH is higher than the FSH just a little. There is no 2:1 ratio like you see in the Classic-Types. 
High normal testosterone or just over the edge of normal testosterone. Let me explain again those ridiculous reference ranges for testosterone blood labs. Most labs have the reference range for testosterone to be 2-45, which is a very wide range. Those with Concealed PCOS will have a testosterone at 35-55. The average levels of testosterone for women regardless of age or menstrual status is about 25, so the Concealed are higher than the average. 
Low progesterone
High normal DHEA-sulfate
Lower thyroid function but not hypothyroid 

Low normal FreeT3
Normal FreeT4
Normal TSH 

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In this episode, we continue talking about PCOS. As mentioned in the previous episode, we have seen three main types of PCOS. PCOS is more of a spectrum of symptoms. Some women have most of the symptoms of PCOS and others just a few. The varying degree of hormonal imbalances will help mold the three types of PCOS that we have seen. Many doctors that treat PCOS all can agree that there are different types of PCOS. 
The three types that we have found with PCOS are:

Classic
Common 
Concealed

In this episode, we are going to talk about the Common-Type of PCOS. In the previous episode, we spoke about the Classic type. And in the next episode, we will go over the Concealed Type.  
The reason that we want to differentiate the Types of PCOS is because, in each type, there are different health goals, health consequences, and multiple treatment plans.
 Common PCOS: This is the most common type of PCOS seen. The Common-types should be diagnosed fairly easily. But because they do not fall into the Classic presentation, they may get missed in diagnosis.  
Symptoms that a PCOS Common-type will present with:

Easy weight gain in the middle, the stomach, and the hips and thighs
Thinning hair
Irritable easily
Some cystic acne on the chin and jaw area
Trouble getting pregnant but is usually successful with fertility options or IVF
May get random cysts on or in the ovaries. But there is no string of pearls or multiple ovarian cysts.  
May miss a period occasionally. Common-types are not regular in their periods. But they may get a period every month for five months then miss two. Or have very long cycles up to 45 days. Or they may have a period every other month. Common-types again, are not regular, but they do not miss multiple months like the Classic Types PCOS.

Typical lab work for a PCOS Common Type:

LH is double the FSH
There is high normal to just slightly over the normal level of testosterone
High normal DHEA-sulfate
Insulin is in the normal range but may show up in the teens or anywhere above 9. 
Normal glucose
Estradiol can be high, showing Estrogen-dominance or be normal ranges

There are three main types of PCOS that we have seen treating patients since 2004. As you have heard from the past podcasts, PCOS is a spectrum of symptoms. It is a spectrum of symptoms coming from a set of hormonal imbalances. Every woman with PCOS might have some to all to a few of the symptoms of PCOS. That is because there might be varying degrees of hormonal imbalances. 
While there might be some disagreement, there are three types that we have encountered the most. And each of these three have different goals and treatment plans.  
These are the main types we have seen in treating patients with PCOS. As I mentioned before, PCOS is a spectrum. There can be some women that have all the symptoms to others that have just a few. This is a key concept for treatment. Someone with many symptoms is going to have a completely different treatment plan than someone that has some of the symptoms. 
The three types that we commonly see, we have named: CLASSIC, COMMON, and CONCEALED.   
Classic PCOS: Honestly, this is not seen that often. A Classic-PCOS, you will see all of the symptoms.  

Dark facial hair
Chronic cystic acne.  
Thin hair, especially the top of the head and temples
Weight gain–being it is super easy to gain weight and what feels like, impossible to lose
High blood pressure
High cholesterol
High blood sugar
High insulin: leading to insulin resistance and possibly diabetes, if not already diabetic.  
Irritability
Terrible carb cravings, especially for sugar. 
Miss multiple periods for consecutive months in a row. They might get maybe two periods a year.  
These are the women that have many cysts in and on their ovaries. They have the Classic' string of pearls visualized on a transvaginal ultrasound.  
Infertility 

You will see the full gamete of the blood work readings:

LH to FSH ratio is 2:1 or even more
High levels of testosterone: well above the normal levels. You can see the testosterone anywhere up to 90 or more
No progesterone levels
Normal levels of estradiol and sometimes there can be higher levels such as Estrogen-Dominance from the conversion of testosterone to estradiol.
High DHEA-sulfate
High insulin, high teens to well over 20
High blood sugar and Hemoglobin A1c
Hyp

PCOS Testing and Diagnosis: In this episode, we talk about the testing and labs for a diagnosis for PCOS. These testing and labs are also a good way to monitor PCOS.
Ultrasound: Checking for multiple cysts on or in the ovaries. It is still very common to have PCOS but have not cysts ( string of pearls ).
LH: FSH ratio:

2:1 or more

DHEA-S:

DHEA-sulfate is the best way to test for DHEA levels in the blood.  
DHEA-sulfate is a metabolite of DHEA and is much more accurate to determine DHEA levels than a total DHEA level.  
DHEA levels are highest when we are young, around 25 years old. And will slowly decline with age. It is considered an androgen.
The reference ranges for DHEA-Sulfate are very vast and are based on age. For example, a woman that is 35 years old gets her blood drawn for DHEA-sulfate. The reference ranges for a typical lab is 23-266 mcg/dL.  
For a female that has PCOS around 35 years of age, you will see the DHEA-sulfate at 200 or above. 
Commonly PCOS, the DHEA-s will show over 200 mcg/dL.  

Testosterone:

The reference ranges for testosterone labs are huge.  
Quest has a reference range of 2-45 ng/dL.  
LabCorp has a reference range of 8-48 ng/dL.  
Testosterone levels at 35 or higher

Estrogen

Three circulating estrogens: Estrone, Estradiol, Estriol

Vast reference typical reference ranges for most labs:

Follicular Phase 19-144pg/mL
Mid-Cycle 64-357
Luteal Phase 56-214
Postmenopausal

In this episode of the Progress Your Health Podcast, we are going to talk about PCOS. I know our last podcast was, PCOS, Questions to Ask your Doctor. We are still going strong on our PCOS information. But we are going to do things a little different than we have. We are going to do a five-part podcast series about PCOS.  

What PCOS Looks Like: What is it? (this podcast)
How PCOS Can Be Detected: Testing and Diagnosis for PCOS
Which Type of PCOS Am I?: Classic
Which Type of PCOS Am I?: Common
Which Type of PCOS Am I?: Concealed

PCOS stands for Polycystic Ovarian Syndrome. It is not a disease but considered a syndrome. From the name, polycystic ovarian syndrome, it is easy to assume there are multiple cysts on the ovaries. But in fact, many women with PCOS do not have multiple cysts or any ovarian cysts. As a general statement, in PCOS, there are hormonal imbalances that can cause unwanted symptoms and conditions. That is why we consider it more of a spectrum as some women can have nearly most of the criteria of PCOS and other just a few symptoms.  
What are the Hormonal Imbalances present in PCOS?

In PCOS, one of the hallmarks are elevated levels of androgens: testosterone and DHEA. A lot of time these can range from high normal to over the reference lab values. 
DHEA: comes from the adrenal glands
Testosterone is from conversion from DHEA, ovaries and other peripheral tissues
Progesterone levels from the ovaries are low to none
Thyroid function can be low
Elevated insulin
Cortisol diurnal release is degraded. 

Common PCOS Symptoms:
Multiple Ovarian Cysts:

Just like the name states: Polycystic ovarian syndrome, there can be multiple cysts on the ovaries.  
It is normal and common to get small follicular cysts during our cycle.  
But in PCOS there can be actual cysts that stay on the ovaries almost indefinitely.
While as the name states, polycystic. Many women with PCOS do not have cysts on their ovaries.

Period issues:

Irregular or lack of a period.
In PCOS, there can be missed periods. Some women might miss a period or two in a year. And others can miss their period for up to six months or more. But of course, the goal is to balance the hormones, so the cycle is regulated and not painful or heavy.

Infertility:

Some women that have PCOS can have reduced ovula

In this episode of the Progress Your Health Podcast, we want to discuss questions you might want to ask your doctor when it comes to PCOS.
PCOS stands for Polycystic Ovarian Syndrome. The name can be misleading. Polycystic means, having multiple cysts on or in your ovaries. While this can be true, many women with PCOS do not have any ovarian cysts. PCOS is a collection of hormonal imbalances that may result in cysts and other unwanted symptoms. 
During this episode, we talk about the diagnosis, symptoms, and questions to ask your doctor regarding PCOS. We explain that PCOS is more of a spectrum of symptoms as some women can have all the symptoms and others a few.  
This is why it is important to have clear communication with your doctor on how:

PCOS is affecting your life.  
What your health goals are with PCOS.  
The proper treatment to help with PCOS. 

Before we move on, let’s understand the basics with PCOS. The common symptoms that are associated with PCOS:
Common PCOS Symptoms: 
Cysts: if you have not had an ultrasound, request that your doctor order you transvaginal ultrasound. As mentioned earlier, many women with PCOS do not have cysts on the ovaries. But if there is any thought that you might have PCOS, then you do want to have a transvaginal ultrasound. This will give us information on the size of the uterus and ovaries. If you have any growths or cysts. It will even check the thickness of the lining of your uterus. 
Missing, Irregular Periods: It is very common in PCOS to miss periods for multiple months. Some women miss one month a year, and others can miss up to six months at a time. It is also common to have cycles that range from 25 days to 45 days.  
Weight gain: Weight gain is one of the most common frustrations with PCOS. It is very easy to gain and hard to lose. Even with strict caloric restriction and a lot of exercise, women with PCOS will be frustrated because they cannot lose weight.
Hair loss: It is common in PCOS to have hair loss. Particularly on the top of the head and temples can appear to be especially thin.  
Hair growth on the face and other areas of the body (except for the head): While it might be easy to lose hair on the head. In PCOS there can be hair growth on other areas of the body. Most commonly, the upper lip, chin and jaw, chest and pubic area before the belly button. We are human, and humans grow hair on our bodies. But in PCOS it might seem a bit more extreme.  
Irritable: It is common to feel irritable not warranted for the situation in PCOS. 
Lack of Conceiving, Fertility issues: PCOS is one of the top causes of infertility. There tends to be a lack of ovulation in PCOS. But there are many women with PCOS that have children. But there is a link between fertility and PCOS.   
Elevated Blood Pressure: Some women with PCOS will have essential hypertension. Or eleva