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This is an article I needed to read! Thanks so much. Can you clarify what you mean by PCOS “subtypes” and whether there are any difference in treatment recommendations between them?

Does that simply refer to which of the 2 or more disgnostic criteria a person meets and what their treatment goals are, or is it something deeper in terms of pathophysiology?

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If OCPs can also shut down ovarian function, why is it that we should be able to see polycystic ovaries on ultrasound for someone who has PCOS? Testosterone should also be decreased and FSH and LH will be altered. I am confused as to how we can still do the workup for PCOS when someone is taking pills. Thanks-

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One of the main drivers of the physical changes in the ovaries is overgrowth of theca cells in the follicles. This happens due to higher insulin levels and so these changes are not reversed by the pill. There may also be genetic factors that we don't understand. While the alterations in FSH/and LH may play a role, it isn't a big effect. None of the guidelines recommend stopping the pill to do the ultrasound.

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